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2. Is there a community group that should be included in the Community Health Assessment and Community Health Improvement Plan in the future?

   1. Yes
   2. No
3. Please enter the name of the community group here
5. Is this group active in Snohomish County, and/or does it serve Snohomish County residents?

   1. Yes
   2. No
   3. I don't know
6. Do you have a point of contact for this community group?

   1. Yes
   2. No
8. Name of contact
9. Email Address
11. Position or role of contact person
13. Phone Number
15. Would you like to submit additional feedback or comments?

    1. Yes
    2. No
17. Please enter any additional feedback or comments here
19. Would you like to provide your contact information?

    1. Yes
    2. No

    Note: Contact information provided in this form may be subject to public records requests. Contact information would be used by Snohomish County Health Department staff to follow up on feedback or questions from this form, or potentially to request participation in future health assessment-related activities. 

21. Name
22. Email Address
24. City of Residence

    Please enter the town or city where you live or "unincorporated Snohomish County" if you are outside of a town or city.

25. Phone Number
27. Roles and Affiliations

    Please note any specific roles or community organizations you are involved in that would be relevant for the Community Health Assessment. 

28. Accessibility Requests

    Please let us know if there are accommodations needed to support communication between you and the Health Department. Examples could include language interpretation requests or specifying a preferred mode of communication (phone call, email, text, etc.)

30. Thank you for your feedback. Your input is important for planning the Community Health Improvement Plan and future Community Health Assessments. Please be sure to click "Submit" to ensure we receive this form. After submitting, you will be redirected back to the www.snohd.org/cha website.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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