**Please only submit a school-based health center if it does not appear on the Ohio SBHC Map. If you have a correction to a site on the map, instead email Rachael Schilling (rachael@osbha.com).**

The Ohio School-Based Health Alliance ("Ohio Alliance") is engaged in ongoing work to create a comprehensive database of school-based health centers in Ohio. This is part of a larger effort to track the growing positive impacts of school-based health centers and other innovative school-based health care delivery models across the state. Once you submit the census form for your SBHC(s), it will be added to the Ohio SBHC Map.

This survey will take about 10-15 minutes to complete. If you are submitting information about multiple SBHC sites, please fill out separate forms for each. The information you provide will help us learn more about the scope and breadth of school-based health care services being provided across Ohio communities. We will ask about the basic healthcare operational model, schools and populations served, services offered, and staffing.

The Ohio Alliance is committed to sharing this data as a resource to improve access to comprehensive, integrated services through school-based health care while respecting the privacy of our partners. We share data in the following ways:
• Inform statewide and local advocacy efforts to increase funding for school-based health care
• Support partnerships and projects that strengthen Ohio’s school-based health care infrastructure
• Publish aggregate findings in presentations or publications
• Upload SBHC names, locations, and basic characteristics into visual graphics and the Ohio SBHC map
• Share data with key research partners to understand programming and trends

If you have any questions, please email Rachael Schilling (rachael@osbha.com).

Thank you for your time!

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* First name

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* Last name

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* Email address

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* Organization

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* Job title

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* Phone number (xxx-xxx-xxxx)

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* School building where SBHC is located. Please enter the school building as it appears in the email. If you have additional SBHC sites to submit, please use THIS FORM.

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