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!

* 1. Please enter provider name.

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

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

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

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