CA-OPEN Sign-Up Survey
Thank you for signing up for CA-OPEN emails. So that we can have a better sense of your interests, please complete the following demographic survey. Thank you.
OK
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1.
What is your name?
(Required.)
2.
Organization name? (if applicable)
3.
Title? (if applicable)
*
4.
Email?
(Required.)
5.
City?
6.
What is your language preference?
English
Spanish
Madarin
Cantonese
Korean
Japanese
Other (please specify)
7.
Type of organization/affiliation (if applicable)? Check all that apply:
Non-profit organization
County government
State government
School supports and services
Social services organization
Community clinic
Private practice - Dental
Private practice - Medical
Private practice - Behavioral health
Hospital
Health plan
Dental plan
Legal aid organization
Foundation
Media company
Advocacy or public policy organization
No affiliation
Other (please specify)
8.
Populations/communities served by you/your organization:
Children
Adults
Seniors
Pregnancy
Current or former foster children and youth
African American
Latinx
Asian American
Pacific Islander
Indigenous
Native American
Alaskan Native
LGBTQIA2S
Adults with disabilities
Children with disabilities
People with substance use disorders
Low-income people
Immigrant communities (please specify)
Refugees
People with limited English proficiency (preferred language other than English)
Providers (please specify)
Policy makers
Other (please specify) or additional details
9.
What are the language capacities of your organization?
10.
Region of the state you/your organization serves:
Statewide
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
11.
CA OPEN has four active forums (work groups) to discuss policy, networking, and other activities and events to support oral health equity work. As we work to make these forums more interactive to our members, please let us know which ones you could be most interested in participating in:
Policy
: meets quarterly to discuss policy opportunities, recommend policy priorities for the year; and identify policy advocacy opportunities to share with the network.
Communications and Engagement
: meeting monthly to review communication needs, develop and disseminate network messages and materials, and identifies training, capacity building, and networking opportunities for members.
Operations
: Meets quarterly to review website needs and updates; develop technology plans and platforms; and offers technology and IT support for the network.
Evaluation and Governance
: Meets quarterly to track progress of the network goals and activities; identify opportunities for growth and sustainability; and recommend infrastructure changes.
12.
We are seeking new ideas and opportunities to align and connect members, which activities would you be most interested in participating in:
Policy and advocacy updates: getting information about federal, state or local policy movements or actions by policymakers and opportunities to weigh in.
Policy and advocacy opportunities: timely opportunities to weigh in on policy issues at the federal, state, and local levels including ways to send letters of support; provide testimony; opportunities to sign on to letters of support/opposition; or ways to contact representatives about a policy issue.
Online training and capacity building on various oral health and advocacy issues
Opportunities to network and collaborate on projects including events and presentations
Submitting oral health tools and resources to the webpage
Submitting nominations or participating in opportunities to highlight members or leaders in oral health to our online newsletter
Convening an event at the local, regional or statewide level
Participating in or getting information about local oral health efforts, events, and information
Participating in or getting information about statewide efforts, events, and information
Other (what other ideas do you have to engage members):
Current Progress,
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