MKE Elevate Involvement and Current Initiatives Survey

The City of Milwaukee Health Department needs your help to elevate the health of the Milwaukee community! Please complete the following survey to indicate your interest in getting involved and to help us better understand the great work already being done to promote positive mental health, create an inclusive fair society, and improve economic security with the goal of creating safe and healthy neighborhoods. In the next phase of the MKE Elevate initiative, we hope to support enhanced collaboration among partners and identify areas of opportunity.

It is possible that multiple individuals within your organization may have received this survey. We apologize for any duplication and ask that, when possible, your organization coordinates its response.

*The survey should take less than 10 minutes to complete.

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* 1. Your Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. Mailing Address:

Street Address:

City/State/Zip:

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* 5. Organization Name (if applicable):

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* 6. Which of the following best describes the primary work of your organization?

NOT APPLICABLE

Health Care

Government

Education

Nonprofit

Other (please describe)

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* 7. Organization Website URL (if applicable):

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* 8. Social Media Information (e.g. Facebook, Twitter, LinkedIn, Instagram, etc.):

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* 9. You are invited to attend the MKE ELEVATE ACTION TEAM MEETING on Tuesday, April 11th from 4-6pm. This meeting will take place at the Martin Luther King Jr. Community Center. Light refreshments will be available. Additional meeting information will be sent as the date approaches. If you are a member of an organization and not able to attend, personally, we encourage you to identify another individual to attend on behalf of your organization. Please indicate your interest and availability in attending the MKE Elevate Action Team Meeting:

I am PLANNING TO ATTEND

I am NOT ABLE TO ATTEND, but am interested in learning about future meetings

I am NOT INTERESTED in attending this or future meetings

I am not able to attend, but ANOTHER INDIVIDUAL from my organization will attend on my behalf. Please provide contact information of the individual attending on your behalf:

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* 10. Would you or someone in your organization be interested in learning more about how to JOIN AN ACTION TEAM to help develop the plan to elevate the health of the Milwaukee community? As a member of an Action Team, you will be invited to attend a series of planning meetings to identify the specific goals, objectives and strategies related to the Priority Action Areas. If so, please indicate which Action Team you would be interested in joining. Please select all that apply:

Positive Mental Health Action Team
(e.g. Reduce chronic stress and improve social and emotional support; Reduce alcohol misuse including binge drinking; Reduce prescription drug and opiate misuse including overdose; Improve access to mental health services)

Fair, Inclusive Society Action Team
(e.g. Eliminate racism; Eliminate discriminatory laws and practices; Address the impact of historical trauma and adverse childhood events; Improve access to culturally and linguistically appropriate services)

Economic Security Action Team
(e.g. Improve access to employment that provides family supporting wages and benefits; Improve access to affordable healthy food; Improve access to affordable safe housing; Improve access to, and quality of, basic services, such as education and transportation)

NOT INTERESTED AT THIS TIME