JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Regional Health Equity Academy in System Transformation Interest Form
If your organization is interested in Families USA holding a regional training on key health equity topics please complete this form.
To learn more about the Health Equity Academy in System Transformation, visit
https://www.familiesusa.org/our-work/health-equity-academy-in-system-transformation/
If you have any questions about the regional training, please contact Shyloe Jones at
sjones@familiesusa.org
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name (First/Last)
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Job Title
*
Your answer
Organization
*
Your answer
Organization Address (Include State, City, and Zip Code)
*
Your answer
How would this training benefit your state/region?
*
Your answer
What health care delivery changes are your state considering and when would these be implemented?
*
Your answer
What policy changes are existing health equity organizations or coalitions advocating for/against in your state?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
