*1.Please provide your email address
(Required.)

*2.Which of the Blueprint Levers are you planning to work on? (check all that apply)(Required.)

Amplify Consumer Voices

Advance Oral Health Policy

Integrate Dental and Medical

Emphasize Prevention

Bring Care to the People

None of the above

3.Which goals in the Blueprint do you, your organization, and/or State work on that will support our collective impact goals?

4.What would you add to ensure equity and inclusion in this work?

*5.Can you think of any individuals or organizations working in any of the lever areas that we should connect with? If yes, provide contact information.(Required.)

6.What resources or other information can you share that will help move the Blueprint work forward?

7.What is the best method for OPEN to communicate with you? (e.g. OPEN Communities, SLACK, email, etc.)

8.How can OPEN support you to actively engage in implementing the Blueprint activities within the Network and in your communities?

9.Do you have any remaining questions or concerns?