Register: 7/29 AM Strategic Planning for Assessing Resources and Gap Analysis

7/29/2024
8:30 am - 12:30 pm PST

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* 1. Email address:

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* 2. First Name:

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* 3. Last Name:

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* 4. Phone Number

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* 5. Agency/Organization

Before the training you will recieve an email with a Zoom link - please watch for that information.

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* 6. What role do you have in the state prevention system? Select one:

Other (please specify)

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* 7. Organization type? Check all that apply:

SUD Prevention

Chemical Dependency/Mental Health/Treatment Agency

Community Organization/Coalition

County/State/Public Agency

School/ESD

Youth-Serving Organization

Non-Profit Organization

Other (please specify)

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* 8. Age range (choose one):

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* 9. Gender (choose one):

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* 10. Pronoun preference (choose one):

She/Her/Hers

He/Him/His

They/Them/Theirs

Other (please specify)

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* 11. Race(s) (multiple selections allowed):

American Indian/Alaska Native non-specified

American Indian/Alaskan Native

Asian non-specified

Asian - Asian Indian

Asian-Chinese

Asian-Filipino

Asian-Japanese

Asian-Korean

Asian-Vietnamese

Black/African American non-specified

Black-Ethiopian

Black-Somalian

Black-West Indian

Native Hawaiian/Other Pacific Islander non-specified

Native Hawaiian/Other Pacific Islander - Native Hawaiian

Native Hawaiian/Other Pacific Islander - Guamanian or Chamorro

Native Hawaiian/Other Pacific Islander - Samoan

Two or More Races

White non-specified

Some Other Race non-specified

Some Other Race (please specify)

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* 12. Ethnicity (choose one):

Hispanic, Latino(a) or Spanish Origin non-specified

Not Hispanic, Latino(a) or Spanish Origin

Mexican, Mexican American or Chicano

Puerto Rican

Cuban

Other Hispanic, Latino(a) or Spanish Origin

Ethnicity Unknown

Other Ethnicity (please specify)

Register: 7/29 AM Strategic Planning for Assessing Resources and Gap Analysis

7/29/20248:30 am - 12:30 pm PST

Question Title

* 1. Email address:

Question Title

* 2. First Name:

Question Title

* 3. Last Name:

Question Title

* 4. Phone Number

Question Title

* 5. Agency/Organization

Question Title

* 6. What role do you have in the state prevention system? Select one:

Question Title

* 7. Organization type? Check all that apply:

Question Title

* 8. Age range (choose one):

Question Title

* 9. Gender (choose one):

Question Title

* 10. Pronoun preference (choose one):

Question Title

* 11. Race(s) (multiple selections allowed):

Question Title

* 12. Ethnicity (choose one):

7/29/2024
8:30 am - 12:30 pm PST