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Assessing Community Engagement Resource Survey

For the Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies project.

Thank you for sharing your insights and feedback on the Assessing Community Engagement Conceptual Model, Impact Stories, and Assessment Instruments!

1. Name

2. Email Address (if you would like to be contacted about your response) This question requires a valid email address.

3. Company or Affiliation

4. Which of these groups do you most strongly identify with? *This question is required.

Federal, state & local agencies, territories & tribal communities
Community-based groups & community members
Patients & patient advocacy organizations
Funders, philanthropists & other investors
Academic & research institutions
Care systems, health centers & hospitals
Systems that impact health outcomes (e.g., housing, transportation, education)
Payers, plans & industry
Other - Write In Please enter an 'other' value for this selection.

5. How familiar are you with engaging communities in your work, efforts, or projects? *This question is required.

6. How familiar are you with assessing and evaluating community engagement? *This question is required.

7. How do you plan on using the Conceptual Model, Impact Stories, and Assessment Instruments? *This question is required.

8. What comments or reflections do you have on the Conceptual Model, Impact Stories, and Assessment Instruments?

9. What questions do you have on the Conceptual Model, Impact Stories, and Assessment Instruments?

10. Would you like to share additional comments about the Conceptual Model, Impact Stories, and Assessment Instruments?