Introductory Survey for M.E.T.A.

Thank you for responding to our invitation to attend the M.E.T.A. meeting on January 17, 2018. M.E.T.A. is a
network of community members, partners, and health professionals who have an interest in the health of Latinos
and/or tobacco control in the Gold Country Region. The Gold Country Region is made up of the following
counties: Stanislaus, San Joaquin, Yolo, Sutter, Mono, Sacramento, Inyo, Placer, Amador, El Dorado, Tuolumne,
Calaveras, Alpine, and Nevada. We encourage you to fill out this survey prior to the meeting to help us guide
future meetings and advocacy efforts.

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* 1. Date:

Date / Time

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* 2. Your Name:

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* 3. Please name the organization that you represent in this Coalition (if any). If you do not represent a
specific organization, please describe what part of the community you most represent as a member of the
Coalition.

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* 4. If you are part of an organization, what is/are the purpose(s) of your organization. (Check all that apply)

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* 5. If your organization serves people of Latino/Hispanic ethnicity, please describe how.

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* 6. Please briefly describe the top 2 to 3 reasons that led to your interest in the Coalition. If appropriate, describe
what you hope to learn, accomplish, or other goals related to your participation.

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* 7. Briefly describe your recent and current participation in any other Coalitions and your participation in any other
tobacco control work.

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* 8. What concerns are most important to you? (Check all that apply)

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* 9. What would you most like to do or accomplish through your participation in the Coalition. Some examples follow to “select.” Please feel free to share additional hopes and preferences. (Check all that apply)

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* 10. Please describe what we can to do to ensure or increase your engagement with the Coalition and tobacco
related advocacy campaigns. This may include ways we arrange our work and meetings, ways we reach out to
you, skills and experiences the Coalition may offer, and anything else.

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* 11. Please list any people or agencies/organizations you believe would be important to engage in the Coalition as
members or supporters.

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* 12. Please tell us if your organization has ways we can use to share information to tobacco control and prevention
and the Coalition. This may include a newsletter, blog, eblast, or other outreach.

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* 13. Please offer any other comments that may help us to grow and strengthen the Coalition and advocacy for
tobacco prevention and control for the Latino community.

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