PVAC Survey 2018 Question Title * 1. What PVAC programs have you participated in? Addressing Asthma in Schools Healthy Homes Climate Change Policy Advocacy (biomass, tobacco21, climate change, etc) Trainings and Presentations Other (please specify) Question Title * 2. What issues would you be interested in working on? Improving indoor air quality in schools Improving indoor air quality in homes Improving outdoor air quality- reducing air pollution Educating families about asthma management Educating professionals about asthma management Advocating for policies to improve air quality Advocating for policies to improve asthma management Addressing climate change Other (please specify) Question Title * 3. What is the best time for the Coalition to meet? Early morning- 8am-9am Morning 9-10 am Lunch 12-1 pm Afternoon 4-5 pm Question Title * 4. What do you want to get out of the Coalition meetings? Education on topics related to asthma Updates on Coalition activities Networking Training on implementing new activities Other (please specify) Question Title * 5. What group do you represent? Schools/education Medical professional Community based or other nonprofit organization City government Community member Parent Policy advocate Funder Other (please specify) Question Title * 6. What other ideas or suggestions do you have for the Coalition? Question Title * 7. Please help us update our list by providing your contact information. Your information is confidential.(If you would like to participate in a committee, we will need your contact information below.) Name: Organization: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Thank you for participating in this survey. Your input will help us plan future activities for the Coalition.We will report on the results to the next Coalition meeting. Done
