MHSA Program Outcomes Workgroup - Interest Survey

Participant Information

Please complete this survey if you are interested in participating in the MHSA Program Outcomes Workgroup. Participation is open to the public.

You must be able to commit to attending all three (3) workgroup meetings scheduled for October 10th, November 14th, and December 12th, 2-3:30pm. The workgroup will be limited to 10-12 participants, which will be selected by an MHSA Steering Committee group to ensure there is diversity in lived experience, cultural and geographic representation. “First-come, first-serve” will also be considered and based on when you submit this survey.

This survey will close on Friday 9/6/24.

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* 1. Please provide your name.

First Name:

Last Name:

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* 2. Please provide your contact information. We will contact you to confirm your participation.

Email:

Phone Number:

Which is the best way to contact you (text, call, e-mail)?

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* 3. Are you a member of any behavioral health-related advocacy group or coalition/collaborative?

Yes. Please list all behavioral health-related groups you are affiliated with:

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* 4. Are you participating as an employee or board member of an organization/agency?

Yes. Please list the organization(s) you are representing and your title/role at each:

MHSA Program Outcomes Workgroup - Interest Survey

Participant Information

Question Title

* 1. Please provide your name.

Question Title

* 2. Please provide your contact information. We will contact you to confirm your participation.

Question Title

* 3. Are you a member of any behavioral health-related advocacy group or coalition/collaborative?

Question Title

* 4. Are you participating as an employee or board member of an organization/agency?

Question Title

* 5. Do you have any relevant experience to help support this process (evaluation, peer/family support work, program planning, other)?