Healthy Mothers, Healthy Babies Partner Survey
First we want to ask some questions about you. This will help us to design a system which will make it easy for you to participate.
What is the name of your organization?
How long have you been with this organization?
Less than 1 year
More than 1 year
Can you name some computer programs or websites (examples: Microsoft office, Facebook, Gmail) that you use often, and that you are comfortable with using?
Which email provider do you use for your everyday email needs?
Microsoft Outlook Mail
Your organization's own custom email service
Do you expect to enter the writing and pictures into the M&I Map application yourself, or do you have someone else (a staff member or a volunteer) in mind to enter the information into the M&I Map application?
I expect to enter the writing and pictures myself.
I expect someone else to enter the writing and pictures.
Do you have some pictures of your programs that you would like to upload and show on the M&I map?
Yes, I would be interested in that feature.
I don't have any pictures now, but I am interested in that feature.
Not interested in posting pictures to the M&I Map
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service