Name *

First Name

Last Name

What is your relationship to 5th Ward?

Resident

Non-Resident Stakeholder

How would you like to get involved in the community health assessment?

Check any/all that apply.

Participate in training to become a paid data collector in my community

Participate in a focus group, interview, or survey

Help recruit 5th Ward residents to participate

Provide feedback during meetings and through the pre- and post-surveys

Help train resident researchers in data collection

Collect new data through my organization

Provide data from my organization

Consult with the assessment team on best practices

Help compile and analyze data

Assist in writing and reviewing the report

I prefer not to be involved