1. Community Provider CBA Survey Introduction:

The following survey was created by The AIDS Institute to gather as much information from community providers (CDC directly funded providers, CDC In-directly funded providers or other providers of HIV prevention services that receive no CDC funding). The survey will assist The AIDS Institute in providing a voice for and educating CBA consumers on relevant issues impacting the quality of capacity building assistance for HIV prevention services.

Please tell your colleagues about this survey – We want to hear from every organization providing HIV/AIDS Prevention services.

If you have completed this survey within the past month, do not complete it again. Only one survey per agency is requested. Thank you!

Please enter provider name.

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* 1. Please enter provider name.

Please enter provider location (Address/US/City/ST/ZIP).

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* 2. Please enter provider location (Address/US/City/ST/ZIP).

Please enter provider's main contact person and title:

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* 3. Please enter provider's main contact person and title:

Please enter provider's main contact email address.

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* 4. Please enter provider's main contact email address.

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