Contact Information for Providers Interested in Talking about the Possibilities of a YAS Advisory Committee

1. Contact Information

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100% of survey complete.

Thank you for your interest in exploring the possibilities of a YAS Advisory Committee (YASAC). Please enter your contact information below and answer the 3 questions. Project RISE will be contacting you soon!

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* 1. Please enter your contact information below.

First Name

Last Name

Title

Organization

Program or Site Name (if applicable)

Email address

Office Phone Number

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* 2. I am available to meet in late August or early September:

Yes

Maybe

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* 3. I prefer:

In-person meetings.

Online meetings.

Either one is fine with me.

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* 4. In addition to meeting to discuss the possibilities of creating a YAS Advisory Committee, we are also looking for a small group to help us to develop a survey that will be sent to all YAS providers to assess their interest in this project. Please only volunteer if you can dedicate an additional 1-3 hours to review and discuss survey questions.

I am interested in helping out with the survey and can dedicate a few hours to this project.

Not right now, thank you!