Community Innovation Pool - Black Maternal Health Design Challenge Survey

WORKSHOP DATES AND TIMES

Colorado Access is organizing a group of mothers and families, community organizations and leaders, medical providers, and others for a four-part series of innovation workshops:

Workshop #1 Monday, July 26th 1:00-4:00pm *Meeting will be held virtually	Workshop #2 Thursday, September 9th 2:00-5:00pm *Meeting will be held virtually
Workshop #3 Tuesday, October 5th 9:30-12:30pm *Not yet determined if in-person or virtual	Workshop #4 Monday, November 1st 11:00am-2:00pm *Not yet determined if in-person or virtual

The goal is to co-create, design and fund solutions to overcome inequities in the health and wellness of black mothers during pregnancy, childbirth and new motherhood.

1.Your interest level (Required.)

I am very interested in participating - sign me up!

I am interested but am not sure I can make all the workshops.

I am interested but would need some accommodations to make that possible.

I have questions and need more information.

Other (please specify)

2.What perspectives do you represent?(Required.)

Personal perspective - I identify as Black and am currently pregnant or have had a child (children) within the last five years.

Community and family perspective - I have an understanding of the concerns from a variety of experiences of Black women and families.

Medical and healthcare perspective - I have an understanding of medical services and supports that are provided to pregnant women and new moms.

Policy perspective - I am able to discuss how policies are impacting pregnant Black women and new moms.

Other (please specify)

3.OPEN HOUSE - On Wednesday, June 30th, 4:00-5:30 PM, and Tuesday, July 13th, 12:00 - 1:30 PM. Colorado Access will host a virtual Q&A session where you can pop on at any time to learn more about the workshop series and ask your questions.

I'd like to attend the Open House - please send me the information to join.

I cannot make this date and time, but I have questions and would like someone to follow up with me.

I will not be attending the Open House, but don't have any questions at this time.

Other (please specify)

4.Recruitment: Do you have ideas how we can continue to get the word out? Do you know of others who might be interested in participating?

5.What else would you like us to know?

6.Contact Information(Required.)

Name

Organization and Job Title (if applicable)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number