Help CHNA 18 Help You!
Take our Five-Minute survey and you could win one of two $25 Panera Gift Cards!*

The West Suburban Community Health Network (known as CHNA 18) is researching ways to better serve our communities.

Please help us by answering this short survey focusing on resources, linkages and communication. We'd love to hear from you about what services you use the most and what types of services and activities are still needed. 

*Surveys must be complete and contact information must be included to be eligible.
 
1.

Are you familiar with CHNA 18 and what we do?

Yes
No
I have an idea but am not sure
  • Comment:

  • 500 characters left.
2.

In which city/town do you live and/or work? Select all that apply.

Brookline
Dedham
Dover
Needham
Newton
Waltham
Wellesley
Weston
Other  
  • Comment:

  • 500 characters left.
3.
Have you ever participated in any of the following CHNA activities? Please check all that apply.

Workshop
Guest Speaker/Event
Topic based training with CEU's
Applied for a grant
Received a grant
I have not participated in a CHNA 18 event or activity
Other  
  • Comment:

  • 500 characters left.
4.
As CHNA 18 focuses on what we provide to our network communities, please choose the TOP TWO types
 
of events you would be most likely to attend.

Workshop (i.e. Using Art to Promote Health)
Topic based training with CEU's (Continuing Education Credit )
Enrichment (Guest Speaker/Topic Expert)
Networking event with community partners, organizations, etc
Other  
  • Comment:

  • 500 characters left.
5.
Please tell us which of the following issues/topics are of most interest to you. Please choose your TOP THREE

Substance Abuse Prevention
Technology & Social Media
Social Determinants of Health (Built Environment, Education, Employment, Housing, Violence, and Social Environment)
Youth issues
Elder issues
Mental Health and Wellness
Self Care
Healthy Lifestyle (nutrition, physical fitness)
Other  
  • Comment:

  • 500 characters left.
6.
Would any of the following increase the likelihood that you would participate in a CHNA 18 event or activity? Please select all that apply.

Morning event
Afternoon event
Online training
Includes breakfast or lunch
Other  
  • Comment:

  • 500 characters left.
7.
Please share how you currently learn about resources in your community (events, services, programs, etc.). Please check all that apply. 

Direct emails or newsletters from agencies and organizations
Coalition emails/newsletters like that from CHNA 18
Word of mouth from friends or colleagues
Schools
Faith-Based Organizations
My local health department
Meetings that include other agencies and organizations such as coalition meetings
Same-type service provider meetings (e.g. school nurses, social workers)
Websites
Other  
  • Comment:

  • 500 characters left.
8.
We are refining how CHNA 18 provides information to our community partners and the public. Please select your preferred method(s) of communication from CHNA 18.

Direct email monthly newsletter
Website
Facebook
Listserv
Twitter
LinkedIn
Other  
  • Comment:

  • 500 characters left.
9.
Finally, which of the following areas describe your primary area(s) of work or interest? Select all that apply. If none of the options apply to you, please add your area/interest in the OTHER section. 

Healthcare
Public health
Education
Social Service/Social Work
Youth Provider
Mental Health
Health and Wellness
Community-Based programming
Other  
  • Comment:

  • 500 characters left.
10.
Thank you for taking the time to answer this survey. We appreciate your thoughts and insight into helping us broaden our services to our community partners. If you would like to receive our monthly email newsletter with health-related news, events and resources in your community, please be sure to include your information below.*

*Must be submitted in order to be entered to win gift card. Gift card winners will be selected via random lottery on June 7th and notified via email and posted on our website.


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

For more information about CHNA 18, check out our website  www.chna18.org and our latest newsletter!