Community Wellness Council - Keeping Valencia County's Community Connected
Essential Connections Survey
Group Name
What is the purpose/focus of your group?
2. What are you missing or needing to fulfill your mission (including data)?
3. If grant funded – Do your deliverables require collaboration?
Yes
No
4. How can the health council assist you in meeting your mission or goals?
Please select all the service sectors or areas of focus that apply to you/your group
Education
Business
Social Service
Government
Faith-based Organization
Law Enforcement/ Emergency Response
Health/Behavioral Health
Advocacy/Policy
Valencia County Community Member
Tribal Member or Employee
Civic Group
Public or Private Funder/Payer
Drug/Alcohol Treatment
Residential Facility
Transportation
Built Enviornment/ Natural Environment
Corrections
Utlities - Public Works
Coaltion
Other
If you checked Other, please describe your sector/population served.
List the partners you work with on a regular basis
Please share your funding sources if appropriate or grants currently being applied for.
Program/Group Strengths
Program/Group Challenges
Contact Email for follow up
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