Engage with ECTIC Survey

1.My Contact Information(Required.)

Name

Company (if applicable)

ZIP/Postal Code

Email Address

Phone Number (optional)

4.I am able to help distribute and/or collect community needs assessment information.

Yes

No

If yes, what groups, locations, or organizations can you help with distribution?

5.I am interested in a student internship experience with ECTIC for:

Other (please specify)

7.I would like to nominate someone for a leadership role for ECTIC.(Required.)

Yes

No

I'd like to nominate myself for a leadership role at ECTIC

8.The person I am nominating for a leadership role for ECTIC is: (Please skip if N/A)

Name

Company (if applicable)

Email Address

Phone Number (optional)

9.Please tell us why you are nominating this person and how you believe this person would help ECTIC. (Please skip this question if N/A)

10.Do you have other great ideas we should be including in efforts to reduce the impact of trauma and enhance resiliency? Let us know!

Engage with ECTIC