Local Collaboration/Project Profile Data Collection Form
This information will help us build a project profile on the All In: Data for Community Health virtual collaboration platform at allin.healthdoers.org. Please visit the site and register your individual profile with the collaboration/project name so that you will be linked to the project group. Encourage other participants to join by visiting allindata.healthdoers.org and using the same collaboration/project name.
Email address *
Contact Name *
Your answer
Collaboration/Project Name *
Your answer
Location of collaboration/project (city, state)
Your answer
Please provide the name of the lead organization(s) for this project.
Your answer
Please provide the name of the key stakeholder organization(s) for this project.
Your answer
Please submit the name and email of main contact for managing your collaboration/project group at allin.healthdoers.org (if different from above).
Your answer
Please give a short narrative description of your collaboration/project.
Your answer
What best describes the lead organization of your collaboration/project?
What sectors are included in your collaboration/project?
If your collaboration/project has a health focus, please select from the following:
If your collaboration/project is sharing (or planning to share) data, what types of data are being shared?
What is the anticipated impact level of your project?
If you are targeting a certain population, please indicate below:
How is your project funded?
Your answer
Please provide links to any logos, artwork, or resources you would like to appear on the collaboration/project page.
Your answer
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