Syndemic Response Alliance Information Request Form
Syndemic Response Alliance (SRA) is an interorganizational program administered by Meae Wellness dedicated to connecting residents of Clarksville-Montgomery County to Education, Prevention, and Treatment resources in the fields of HIV/STI Prevention and Substance Abuse.

By completing the following questionnaire you agree to be contacted by an SRA representative regarding participation in one or more SRA related programs.
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Privacy Notice
This privacy notice discloses the privacy practices for the Syndemic Response Alliance Information Request.
This privacy notice applies solely to information collected by this form.

Information Collection, Use, and Sharing
We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you.
We will not sell or rent this information to anyone.
We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization without your direct permission.
Unless you ask us not to, we may contact you via email or other methods provided in the future to tell you about updates, new programs or services, or changes to this privacy policy.

Your Access to and Control Over Information
You can change your information or opt out of communication at any time by contacting us via email address or telephone, and in some case in person.
You have the right at any time to: See what data we have about you, if any; Change/correct any data we have about you; Have us delete any data we have about you; Express any concern you have about our use of your data.

Security
We take precautions to protect your information. When you submit sensitive information, your information is protected both online and offline. Wherever we collect sensitive information, that information is encrypted and transmitted to us in a secure way. You can verify this by looking for a lock icon in the address bar and looking for "https" at the beginning of the address of the Web page. While we use encryption to protect sensitive information transmitted online, we also protect your information offline. Only employees who need the information to perform a specific job (for example, case management) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information are kept in a secure environment.

If you feel that we are not abiding by this privacy notice, you should contact us immediately via telephone at (931) 820-0265 or via email compliance@Syndemicresponsealliance.org
Do you agree to to the Privacy Notice, as stated above? *
If "No," please stop and exit questionnaire.
Do you agree to be contacted by an Advocate regarding participation in one or more programs, based on information provided in this form? *
If "No," please stop and exit questionnaire.
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