Interest Form: Medicaid to Schools Spring 2025 Site Visits

The New Hampshire Medicaid to Schools Resource Center is conducting site visits in collaboration with UNH’s Institute for Health Policy and Practice to learn more about successes and challenges that schools face in the NH MTS system.

These site visits are designed to discuss MTS implementation, identify successes, offer support, and identify resources. Participants will have the opportunity to guide discussion based on their school’s needs and what they would like to discuss. These in-person visits will help to provide insight into ways to improve the program to better support staff and students.

Additionally, participants may indicate their interest in having Medicaid staff attend the site visits, depending on scheduling and availability.

Please complete this form to indicate your interest in a site visit. Our team will be in touch!  

Sign in to Google to save your progress. Learn more
Email *
Name (first and last): *
Phone Number *
School Name *
School Address *
Are you open to/interested in having a staff member from the NH Medicaid Office and/or UNH Institute for Health Policy & Practice attend your school's site visit? 

Please note that selecting "yes" for this question does not guarantee that a staff member from the NH Medicaid Office and/or UNH will attend your site visit. Participation in site visits will be based on the Medicaid Office's scheduling availability. 
 *
Would you prefer to meet in-person or virtually? 
Clear selection
We reserve a section of the agenda for you to choose a topic or activity. Please share below if you have an agenda item or topic in mind for this section of the agenda:

We can also work with you to design an agenda item if you prefer!
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of JSI Research & Training Institute Inc.

Does this form look suspicious? Report

Google Forms