HealthierHere Engagement Interest Form

HealthierHere Engagement Interest Form

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Thank you for taking the time to fill out this brief interest form. We greatly appreciate your input!

1. Describe your relationship with HealthierHere

I have engaged with HealthierHere in the pastI am new to engaging with HealthierHere

2. What engagement opportunities currently interest you with HealthierHere? Select all that apply.

HealthierHere NewsletterVirtual convenings and learning spacesIn-person convenings and learning spacesTopic-specific, action-oriented workgroupsPartnership through HealthierHere's Community Care NetworkOther

You selected "other," please specify below.

3. What topics are you interested in learning more about through HealthiereHere? Some examples include learning about new and innovative programming, advancing equity and anti-racism, and supporting the community-based workforce.

4. What style/format of HealthierHere convenings are of interest to you? Select all that apply.

TrainingsResource sharingRelationship building and networkingOther

You selected "other," please specify below.

5. What are things that HealthierHere can do to improve convenings and engagement opportunities? Select all that apply.

Technical assistance (for virtual convenings)Adjust meeting structures (presentations, breakouts, Q&A, etc.)Focus on topics that are more relevant to my organizational and community needsMore frequent communication about opportunitiesCommunication about opportunities through different channelsI don't have enough information to answer this questionThis is not applicable to me at this timeOther

You selected "other," please specify below.

5. What do you need to be able to engage further with HealthiereHere?

More resources and information about convenings and engagement opportunitiesA 1:1 call with a HealthierHere staff memberAn informational webinar about HealthierHereOther

You selected "other," please specify below.

6. If you expressed interest in the Community Care Network in question 2, which of the following engagement opportunities within the network interest you? Select all that apply.

Providing case management for the Community Hub to support clientsUtilizing HealthierHere’s technology solution for case management/Resource Directory and access to the Community Information ExchangeProviding resources to address Health Related Social Needs (HRSNs) identified by clients Referring clients into the Community HubReceiving referrals from the Community Hub to serve clientsGetting training and guidance to build organizational capacity and serve as a Network Partner Participating in learning and sharing spacesOther

You selected "other," please specify below.

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7. Any additional comments?

Yes, I have more thoughts to share with HealthierHere.No, I don't have additional comments at this time.

What are your additional comments?

Name

Organization

Email contact

Phone number (optional)

If you have questions about the Community Care Network, please submit them through this form: www.healthierhere.org/connect.

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