Meeting Participants and Their Organizations

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. If applicable, please let us know your nurse or social work license number and state.

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* 5. Your Role in Your Organization

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* 6. Organization Categories
Some of the issues that jeopardize mother and child health are beyond the scope of the health care system to solve. Healthy Start is committed to working with other organizations to improve the lives of its participants. Which of the following categories describe your organization or people in your organization? (Check all that apply.)

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* 7. Other Community Services
If you checked  "Providers of Other Community Services" in the previous question, please describe the types of services that your organization provides.

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