1. General Program Information

Greetings! And thank you for taking just a few minutes to share some information with us.

We are gathering information on child and adolescent violence prevention and health promotion programs in Minnesota.

To begin with, we'd like you to name the agency or organization you work for. Next, we're asking about specific programs. You are invited to tell us about up to three individual programs that your agency or organization runs. Be sure that in subsequent questions, you always refer to the same program when talking about your Program One, Program Two or Program Three.

If your agency or organization has only one child or adolescent violence prevention or health promotion program, go ahead and skip all Program Two or Program Three questions. If you have only two, skip Program Three questions.

If you have more than three programs, contact Maureen Holmes (maureen.holmes@state.mn.us) and we'd be happy to offer you the opportunity to complete the survey additional times.

* 1. Agency or Organization Name (for example, Minnesota Department of Health, St. Paul Ramsey County Department of Public Health, City of Minneapolis, Ramsey County Community Corrections):

* 2. List the names of up to three programs within your agency or organization. These programs should be those working to promote child and adolescent health and/or prevent violence toward and among children and adolescents.

* 3. List contact information (including address, telephone, e-mail and web-sites) for each of the programs listed in the previous question.

Be sure that your response for Program One refers to the Program One you described in the previous question.

* 4. For each program, describe how many staff have a minimum of 4 years (or an applicable BA degree) of training in child and adolescent health promotion and/or violence prevention.

* 5. Including staff salary, choose the category that best describes the annual budget for each of the programs you have listed.

  $0-$24,999 $25,000-$49,999 $50,000-$99,999 $100,000-$199,999 $200,000-$299,999 $300,000-$499,999 $500,000+
Program One
Program Two
Program Three