MIPPA Grantee Survey: Assessment of Training and Technical Assistance (TA) Needs

Demographics

Please answer the following questions. We will keep your individual responses separate from any identifying information.

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* 1. Organization Type

State Health Insurance Assistance Program (SHIP)

Area Agency on Aging (AAA)

Aging and Disability Resource Center (ADRC)

Other (please specify)

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* 2. Organization Name

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* 3. Position Title

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* 4. State