Thanks for taking our survey so we can respond to your
community's needs.

Name of County

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* 1. Name of County

Name of Health Educator (or other contact with title)

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* 2. Name of Health Educator (or other contact with title)

Phone

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* 3. Phone

Email Address:

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* 4. Email Address:

Does your HD use any UNYPC poison prevention
materials?

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* 5. Does your HD use any UNYPC poison prevention
materials?

If Yes, please check all that apply.

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* 6. If Yes, please check all that apply.

Do you download any materials from the UNYPCC website?

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* 7. Do you download any materials from the UNYPCC website?

If NO, please select all reasons why not

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* 8. If NO, please select all reasons why not

What might encourage you to use the UNYPC poison
prevention materials?

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* 9. What might encourage you to use the UNYPC poison
prevention materials?

Would you be interested in attending a webinar to learn more
about the UNYPC programs and materials?

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* 10. Would you be interested in attending a webinar to learn more
about the UNYPC programs and materials?

Please select from the list, any of the groups you interact with

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* 11. Please select from the list, any of the groups you interact with

Please list any idea you might have for collaborating with the  UNYPC on a poison safety project.

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* 12. Please list any idea you might have for collaborating with the  UNYPC on a poison safety project.

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