If there is an asterisk "*" at the end of question, it means an answer is required. We ask that you complete questions 1-6. Questions 7, 8, and 9 are optional.
1. What type of organization do you represent (check all that apply):
Local Health Department
State or Local Coalition
Community Health Organization
Clinic or Medical Practice
Academic Institution (College, University)
Medical/Health Professional Association
Faith Based Organization
Person with Asthma
Parent of Child with Asthma
2. Name of organization (optional):
If you can see this field, please leave it blank.
3. What is your position in the organization (check all that apply): *
4. How will you use this plan (check all that apply): *
Community-level Strategic Planning
5. For each statement below, please select the choice that best reflects your opinion: *
a. This plan is clear and easy to understand.
b. This plan is well-organized.
c. The plan reflects the issues most important to addressing asthma in North Carolina..
d. The plan has helped me to structure and develop my asthma-related activities and interventions..
6. Please rate the usefulness of each section: *
a. The Executive Summary was:
b. Asthma is a Public Health Priority was:
c. The Burden of Asthma in North Carolina was:
d. The Planning Process was:
e. The Strategic Plan (by topic area):
1. Education and Public Awareness:
2. Health Disparities:
3. Medical Management:
f. The Evaluation Plan was:
7. Please list any other content areas that you would like to see represented in future editions of the plan:
8. Please list any organizations (name, phone #, email address) you feel would benefit from this plan:
9. Other comments/suggestions:
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