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:
(Required.)
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2.
First Name:
(Required.)
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3.
Last Name:
(Required.)
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4.
Phone Number
(Required.)
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5.
Agency/Organization
(Required.)
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:
(Required.)
CPWI Coalition Coordinator/Staff
CPWI Coalition Member/Volunteer
Tribal Prevention Planner
Community Based Organization (CBO)
DFC Coalition Staff
DFC Coalition Member
Other Prevention Coalition Staff
ESD or School Staff
DBHR Staff
State Partner Agency Staff
Other (please specify)
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7.
Organization type? Check all that apply:
(Required.)
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):
(Required.)
18-20
21-24
25-44
45-64
65+
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9.
Gender (choose one):
(Required.)
Female
Male
Gender Fluid
Non-Binary
Transgender
Gender Neutral
Two Spirit
Unknown
Refuse to State
Something else fits better
Other (please specify)
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10.
Pronoun preference (choose one):
(Required.)
She/Her/Hers
He/Him/His
They/Them/Theirs
Other (please specify)
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11.
Race(s) (multiple selections allowed):
(Required.)
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):
(Required.)
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)
Current Progress,
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