MRBN Resilience Building: 2019 Environmental Scan

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* 1. What is the name of your program/primary initiative?

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* 2. Briefly describe your program/primary initiative and please include your organization or agency affiliation.

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* 3. What are the key goals/outcomes of your program/primary initiative?

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* 4. What is your target population? Select all that apply.

Children

Adolescents

Families

Businesses

Coalition

Community members

Other (please specify)

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* 5. What is the area, county, or state that this program/primary initiative covers?

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* 6. What is the time frame and/or duration?

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* 7. What is the funding source(s)?

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* 8. Is there any data, literature, or resources supporting your work?

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* 9. Are there links to more information or resources that you could share?

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* 10. Who is the lead person on your program or primary initiative?

Name

Email

Phone number

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* 11. Would you like to highlight your program at a future MRBN meeting?

Yes

No

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* 12. Do you have any technical assistance or training need that MRBN can provide or facilitate?

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* 13. MRBN is always willing to connect you with other programs and leaders across Maine to build resilience, would you be interested in this?

Yes

No