* 1. Where does your organization provide services? Mark all that apply.

* 2. What is your role in your organization?

* 3. What sector(s) is your organization?

* 4. Please rank (1 is most important) the following factors (and add others) in order of importance to improve health equity among the clients you serve:

* 5. Please use this space to add any other factors to improve health equity among the clients you serve.

* 6. Please rank (1 is most important) the following (and add others) in order of what would be most helpful to your organization to support addressing health equity in your work. Feel free to note any specific topics.

* 7. Please use this space to add any other suggestions of what would be helpful to your organization to support addressing health equity in your work.

* 8. Among those you serve, which populations or groups (race/ethnicity, geography, language, age, gender, sexual orientation, other) does your organization consider to be excluded or marginalized populations experiencing health inequities?

* 9. Please share some examples of what your organization is doing to address health equity.

* 10. What would your organization want to do to improve health equity in our region and what do you need to do it?

* 11. Please share any other comments you may have.

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