2. What is the type of organization you work for? (Please check all that apply.) *This question is required.

• Childcare/Early Childhood
• Community-Based Organization
• Government Agency - Local
• Government Agency - State
• Government Agency - Federal
• Healthcare focused non-profit organization
• Health Department
• Higher Education

• Housing
• Hospital
• Mental Health
• Patient Advocacy Group
• Philanthropic Org/Private Foundation
• Policy
• Private Practice
• Other - Write In Please enter an 'other' value for this selection.

3. What best describes your role in that organization? (Please check all that apply.) *This question is required.

• Administrator (e.g., Dept chair, program director, program manager, etc.)
• Advocate
• Consultant
• Educator
• Evaluator/Researcher
• Executive (e.g., COO, CFO, CMO, CNO, VP, etc.)
• Patient/Family Member

• Provider (e.g., MD, RN, etc.)
• Public Health Professional (community health worker, home visitor, patient navigator, etc.)
• Quality Improvement Professional
• Social Worker
• Student
• Support Staff
• Other - Write In Please enter an 'other' value for this selection.

4. Are you a parent or caregiver?

• Yes
• No

5. What is your main connection to NICHQ? (Please check all that apply.) *This question is required.

• I turn to NICHQ for useful information and resources
• I currently participate in a NICHQ-led project (member of an improvement team, requested TA and support, etc.)
• I participated in a past NICHQ-led project (member of an improvement team, requested TA and support, etc.)
• I have accessed a NICHQ program or course
• I work for an organization that has funded a NICHQ project
• Other - Write In Please enter an 'other' value for this selection.

6. How long have you been familiar with NICHQ? *This question is required.

Less than 1 year	1 year or more	2 years or more	3 years or more	4 years or more
Less than 1 year	1 year or more	2 years or more	3 years or more	4 years or more

8. Based on your current knowledge of NICHQ, please rate your level of agreement with the following statements. (For each, use a scale of 1-10 with 1 = do not agree at all and 10 = completely agree.) *This question is required.

Space Cell	1	2	3	4	5	6	7	8	9	10	N/A
NICHQ is a leader in improving children's health in our country.	NICHQ is a leader in improving children's health in our country.: 1	NICHQ is a leader in improving children's health in our country.: 2	NICHQ is a leader in improving children's health in our country.: 3	NICHQ is a leader in improving children's health in our country.: 4	NICHQ is a leader in improving children's health in our country.: 5	NICHQ is a leader in improving children's health in our country.: 6	NICHQ is a leader in improving children's health in our country.: 7	NICHQ is a leader in improving children's health in our country.: 8	NICHQ is a leader in improving children's health in our country.: 9	NICHQ is a leader in improving children's health in our country.: 10	NICHQ is a leader in improving children's health in our country.: N/A
NICHQ's improvement methods work well.	NICHQ's improvement methods work well.: 1	NICHQ's improvement methods work well.: 2	NICHQ's improvement methods work well.: 3	NICHQ's improvement methods work well.: 4	NICHQ's improvement methods work well.: 5	NICHQ's improvement methods work well.: 6	NICHQ's improvement methods work well.: 7	NICHQ's improvement methods work well.: 8	NICHQ's improvement methods work well.: 9	NICHQ's improvement methods work well.: 10	NICHQ's improvement methods work well.: N/A
NICHQ's staff are very knowledgeable about issues affecting children's health.	NICHQ's staff are very knowledgeable about issues affecting children's health.: 1	NICHQ's staff are very knowledgeable about issues affecting children's health.: 2	NICHQ's staff are very knowledgeable about issues affecting children's health.: 3	NICHQ's staff are very knowledgeable about issues affecting children's health.: 4	NICHQ's staff are very knowledgeable about issues affecting children's health.: 5	NICHQ's staff are very knowledgeable about issues affecting children's health.: 6	NICHQ's staff are very knowledgeable about issues affecting children's health.: 7	NICHQ's staff are very knowledgeable about issues affecting children's health.: 8	NICHQ's staff are very knowledgeable about issues affecting children's health.: 9	NICHQ's staff are very knowledgeable about issues affecting children's health.: 10	NICHQ's staff are very knowledgeable about issues affecting children's health.: N/A
NICHQ is an innovative organization.	NICHQ is an innovative organization.: 1	NICHQ is an innovative organization.: 2	NICHQ is an innovative organization.: 3	NICHQ is an innovative organization.: 4	NICHQ is an innovative organization.: 5	NICHQ is an innovative organization.: 6	NICHQ is an innovative organization.: 7	NICHQ is an innovative organization.: 8	NICHQ is an innovative organization.: 9	NICHQ is an innovative organization.: 10	NICHQ is an innovative organization.: N/A
NICHQ connects me to the best people and ideas for improving children's health.	NICHQ connects me to the best people and ideas for improving children's health.: 1	NICHQ connects me to the best people and ideas for improving children's health.: 2	NICHQ connects me to the best people and ideas for improving children's health.: 3	NICHQ connects me to the best people and ideas for improving children's health.: 4	NICHQ connects me to the best people and ideas for improving children's health.: 5	NICHQ connects me to the best people and ideas for improving children's health.: 6	NICHQ connects me to the best people and ideas for improving children's health.: 7	NICHQ connects me to the best people and ideas for improving children's health.: 8	NICHQ connects me to the best people and ideas for improving children's health.: 9	NICHQ connects me to the best people and ideas for improving children's health.: 10	NICHQ connects me to the best people and ideas for improving children's health.: N/A
NICHQ improves the lives of marginalized children and families.	NICHQ improves the lives of marginalized children and families.: 1	NICHQ improves the lives of marginalized children and families.: 2	NICHQ improves the lives of marginalized children and families.: 3	NICHQ improves the lives of marginalized children and families.: 4	NICHQ improves the lives of marginalized children and families.: 5	NICHQ improves the lives of marginalized children and families.: 6	NICHQ improves the lives of marginalized children and families.: 7	NICHQ improves the lives of marginalized children and families.: 8	NICHQ improves the lives of marginalized children and families.: 9	NICHQ improves the lives of marginalized children and families.: 10	NICHQ improves the lives of marginalized children and families.: N/A
NICHQ’s work and resources help improve health equity for children.	NICHQ’s work and resources help improve health equity for children.: 1	NICHQ’s work and resources help improve health equity for children.: 2	NICHQ’s work and resources help improve health equity for children.: 3	NICHQ’s work and resources help improve health equity for children.: 4	NICHQ’s work and resources help improve health equity for children.: 5	NICHQ’s work and resources help improve health equity for children.: 6	NICHQ’s work and resources help improve health equity for children.: 7	NICHQ’s work and resources help improve health equity for children.: 8	NICHQ’s work and resources help improve health equity for children.: 9	NICHQ’s work and resources help improve health equity for children.: 10	NICHQ’s work and resources help improve health equity for children.: N/A

9. Based on your current knowledge, please rate NICHQ's level of impact in the following areas. (For each, use a scale of 1-10 with 1 = no impact at all and 10 = extremely high impact.) *This question is required.

Space Cell	1	2	3	4	5	6	7	8	9	10	N/A
Increasing equity	Increasing equity: 1	Increasing equity: 2	Increasing equity: 3	Increasing equity: 4	Increasing equity: 5	Increasing equity: 6	Increasing equity: 7	Increasing equity: 8	Increasing equity: 9	Increasing equity: 10	Increasing equity: N/A
Reducing disparities by race	Reducing disparities by race: 1	Reducing disparities by race: 2	Reducing disparities by race: 3	Reducing disparities by race: 4	Reducing disparities by race: 5	Reducing disparities by race: 6	Reducing disparities by race: 7	Reducing disparities by race: 8	Reducing disparities by race: 9	Reducing disparities by race: 10	Reducing disparities by race: N/A
Reducing disparities by gender/sexuality	Reducing disparities by gender/sexuality : 1	Reducing disparities by gender/sexuality : 2	Reducing disparities by gender/sexuality : 3	Reducing disparities by gender/sexuality : 4	Reducing disparities by gender/sexuality : 5	Reducing disparities by gender/sexuality : 6	Reducing disparities by gender/sexuality : 7	Reducing disparities by gender/sexuality : 8	Reducing disparities by gender/sexuality : 9	Reducing disparities by gender/sexuality : 10	Reducing disparities by gender/sexuality : N/A
Reducing disparities by ability	Reducing disparities by ability: 1	Reducing disparities by ability: 2	Reducing disparities by ability: 3	Reducing disparities by ability: 4	Reducing disparities by ability: 5	Reducing disparities by ability: 6	Reducing disparities by ability: 7	Reducing disparities by ability: 8	Reducing disparities by ability: 9	Reducing disparities by ability: 10	Reducing disparities by ability: N/A

12. On a scale of 0-10, how likely are you to recommend NICHQ to a friend or colleague? (0 not at all likely, 10 extremely likely) *This question is required.

0	1	2	3	4	5	6	7	8	9	10
0	1	2	3	4	5	6	7	8	9	10