Employer Landscape in Illinois

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1. Name (Required.)

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2. Email (Required.)

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3. Phone (Required.)

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4. What is the name of your organization? (Required.)

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5. What is the address of the organization? (Required.)

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6. Location of Organization (county) (Required.)

Other or Multiple Counties (please specify)

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7. Type of organization? (Required.)

FQHC

Health System

Local Health Department

Behavioral Health Center

Social Services Agency

Local and Community-Based Organization ex) faith-based, non-profit, library, school etc.

Other (please specify)

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8. Please list any organizations you collaborate or partner with?

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9. Do you bill for any of the following services provided? (Required.)

Licensed Clinical Social Worker

Nurse Practitioner

Registered Dietitian

Certified Nurse Midwife

Certified Professional Midwife

Pharmacist/ PharmD

None of the above

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10. Do you currently employ any of the following? (Required.)

Community Health Workers/Promotores de Salud

Lactation Specialist

Perinatal Doulas

Peer Recovery Support Specialist

Street Outreach Workers

Respite Care Providers

Licensed Clinical Social Workers

Nurse Practitioners

Registered Dietitians

Certified Nurse Midwives

Certified Professional Midwives

Pharmacist/PharmD

Not yet, but plan to in the future

Other helping professional (please specify)

Employer Landscape in Illinois

Question Title

* 1. Name (Required.)

Question Title

* 2. Email (Required.)

Question Title

* 3. Phone (Required.)

Question Title

* 4. What is the name of your organization? (Required.)

Question Title

* 5. What is the address of the organization? (Required.)

Question Title

* 6. Location of Organization (county) (Required.)

Question Title

* 7. Type of organization? (Required.)

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* 8. Please list any organizations you collaborate or partner with?

Question Title

* 9. Do you bill for any of the following services provided? (Required.)

Question Title

* 10. Do you currently employ any of the following? (Required.)

1. Name (Required.)

2. Email (Required.)

3. Phone (Required.)

4. What is the name of your organization? (Required.)

5. What is the address of the organization? (Required.)

6. Location of Organization (county) (Required.)

7. Type of organization? (Required.)

8. Please list any organizations you collaborate or partner with?

9. Do you bill for any of the following services provided? (Required.)

10. Do you currently employ any of the following? (Required.)