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TA/PEER LEARNING INTEREST SURVEY
Building Systems to Improve Indoor Air Quality

This brief survey is for anyone potentially interested in accessing a peer learning community and/or receiving customized technical assistance (TA) at no charge to support your local efforts to improve indoor air quality. The survey should take no more than 5 minutes to complete. There aren't any right answers, so please just answer honestly and to the best of your knowledge to help us design the best learning experience for you.
Note: This survey/these resources are designed for change agents working to take systems-level action to holistically address indoor air quality (IAQ). Similar technical assistance, support, and resources are also available for those building the systems, infrastructure, and financing needed to support and advance their efforts to establish or expand home-based asthma services. If you are interested in learning more about that project or aren’t sure which project is right for you, please contact Laura Fudala at lfudala@nchh.org.
1.Please enter your name and contact information:(Required.)
2.In addition to the resources available in our IAQ Tools Inventory, flexible coaching and support, also called customized technical assistance (TA), and access to peer learning activities may also be available at no charge. Please indicate whether you are interested in receiving customized TA or learning more about potential peer learning activities:
3.How much do you already know about comprehensively addressing indoor air quality?  There is no right answer, so please answer candidly. This information will help us provide a better learning experience for you.
4.What indoor air contaminant(s) do you currently address in your work?
5.The following questions (#5-12) ask about a range of support needs your community might have. There is no right answer, so please answer candidly. This information will help us provide a better learning experience for you.

My community needs support improving local decision-makers' knowledge about health risks related to: (select all that apply)
6.My community needs support improving the general public's knowledge about health risks related to: (select all that apply)
7.My community needs support improving community resources to help residents find exposures to common indoor air contaminants including: (select all that apply)
8.My community needs support improving community resources to help residents fix exposures to common indoor air contaminants including: (select all that apply)
9.My community needs support helping residents overcome barriers to eligibility for services and/or difficulty accessing funding across programs to address exposures to one or more common indoor air quality contaminant(s):
10.My community needs support establishing coalitions and partnerships that work on one or more indoor air quality issue(s):
11.My community needs support helping established coalitions and partnerships that work on one or more indoor air quality issue(s) function effectively:
12.My community needs support in looking to address common indoor air contaminants comprehensively, rather than by individual exposure pathway:
13.How confident do you feel about your ability to take action and/or your knowledge related to each of the following topics to support systems-level action to holistically address indoor air quality (IAQ)?
Extremely Confident
Somewhat Confident
Not at All Confident
Not Sure
Developing Partnerships Across Sectors to Address IAQ
Using Data to Drive Action and Metrics to Evaluate Success
Learning from Existing IAQ Policies, Programs, Legislation, and Services
Building IAQ Workforce Capacity Through Training and Educational Resources 
Studying Best Practices in IAQ Interventions, Policies, and Services to Improve the Home Environment
Engaging and Empowering Residents and Community Members to Address IAQ Concerns
Developing Financing and Funding Strategies for IAQ Programs and Services 
Educating Stakeholders About Opportunities to Act on Improving IAQ 
14.Which topics are you most interested in learning more about? Check all that apply.
15.How equipped do you feel right now to take part in or lead action to advance systems-level change to holistically address indoor air quality (IAQ) in your state or community?
16.What else, besides the resources in our IAQ Tools Inventory, peer opportunities, and/or flexible TA, do you need to help you feel more equipped to take action in your state or community to holistically address IAQ?
17.Is there anything else you want us to know about you, your state, your community, or your work to improve indoor air quality?