CA-OPEN Sign-Up Survey Thank you for signing up for CA-OPEN emails. So that we can have a better sense of your interests, please complete the following demographic survey. Thank you. OK Question Title * 1. What is your name? OK Question Title * 2. Organization name? (if applicable) OK Question Title * 3. Title? (if applicable) OK Question Title * 4. Email? OK Question Title * 5. City? OK Question Title * 6. What is your language preference? English Spanish Madarin Cantonese Korean Japanese Other (please specify) OK Question Title * 7. Type of organization/affiliation (if applicable)? Check all that apply: Non-profit organization County government State government School supports and services Social services organization Community clinic Private practice - Dental Private practice - Medical Private practice - Behavioral health Hospital Health plan Dental plan Legal aid organization Foundation Media company Advocacy or public policy organization No affiliation Other (please specify) OK Question Title * 8. Populations/communities served by you/your organization: Children Adults Seniors Pregnancy Current or former foster children and youth African American Latinx Asian American Pacific Islander Indigenous Native American Alaskan Native LGBTQIA2S Adults with disabilities Children with disabilities People with substance use disorders Low-income people Immigrant communities (please specify) Refugees People with limited English proficiency (preferred language other than English) Providers (please specify) Policy makers Other (please specify) or additional details OK Question Title * 9. What are the language capacities of your organization? OK Question Title * 10. Region of the state you/your organization serves: Statewide Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba OK Question Title * 11. CA OPEN has four active forums (work groups) to discuss policy, networking, and other activities and events to support oral health equity work. As we work to make these forums more interactive to our members, please let us know which ones you could be most interested in participating in: Policy: meets quarterly to discuss policy opportunities, recommend policy priorities for the year; and identify policy advocacy opportunities to share with the network. Communications and Engagement: meeting monthly to review communication needs, develop and disseminate network messages and materials, and identifies training, capacity building, and networking opportunities for members. OK Question Title * 12. We are seeking new ideas and opportunities to align and connect members, which activities would you be most interested in participating in: Policy and advocacy updates: getting information about federal, state or local policy movements or actions by policymakers and opportunities to weigh in. Policy and advocacy opportunities: timely opportunities to weigh in on policy issues at the federal, state, and local levels including ways to send letters of support; provide testimony; opportunities to sign on to letters of support/opposition; or ways to contact representatives about a policy issue. Online training and capacity building on various oral health and advocacy issues Opportunities to network and collaborate on projects including events and presentations Submitting oral health tools and resources to the webpage Submitting nominations or participating in opportunities to highlight members or leaders in oral health to our online newsletter Convening an event at the local, regional or statewide level Participating in or getting information about local oral health efforts, events, and information Participating in or getting information about statewide efforts, events, and information Other (what other ideas do you have to engage members): OK DONE