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pZB8QmFXydD5hBNNpnK5YHFdiXtNutCfvZs2hcjXwM7eQZArHnKxTaEUzyZ9V3KbrYI4Ix8UsViPUyxFcazRTUmQ

Strategy Team Recruitment Interest Survey

Thank you for taking the time to complete this interest survey! The survey will be open until November 11th. Once the survey has closed, the Minnesota Department of Health will be in touch with additional information.

Please note, depending on the number of people interested in participating as a team member, you may not be assigned to the team of your choice. For more information, visit the Child and Family Health Strategy Teams webpage.

First Name:

* must provide value

Last Name:

* must provide value

Job Title:

Email:

* must provide value

Phone Number:

* must provide value

Organization Name:

Please select the organization/group you work for/represent:

* must provide value

Other, please explain:

Do you have professional or community experience in promoting child and family health and well-being?

Yes

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Do you have professional or community experience in reducing health inequities in Minnesota?

Yes

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Do you have experience working with any of the following communities?

People of Color

American Indians

Rural

LGBTQ

Disability

Immigrant/Refugee

People with Limited English Proficiency

Adolescent/Young Adults

Other

Other (please explain):

Please provide any additional information you want to provide about your personal or professional experience:

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• Care during Pregnancy and Delivery: Increasing accessible, quality health care during pregnancy and delivery.
• Infant Mortality: Reducing the number of infants that die before their first birthday.
• Comprehensive Early Childhood Systems: Ensuring Minnesota has inclusive systems that link young children and their families to all the support and services they need.
• Adolescent Suicide: Reducing the number of youth who take their own life.
• Access to Services and Supports for Children and Youth with Special Health Needs: Ensuring all kids and families have what they need to thrive.
• Housing: Increasing safe, affordable, stable housing for all people living in Minnesota.
• Accessible and Affordable Health Care: Comprehensive, quality health care services, including Family Planning, that are available and affordable for all.
• Mental Well-Being: Ensuring all people living in Minnesota have the opportunity to realize their abilities, deal with day-to-day stress, have meaningful relationships and contribute to their family and community. Including building resilience in those who experience childhood trauma and adversity.
• American Indian Family Health: Reducing disparities and supporting the well-being of American Indian families.
• Parent and Caregiver Support: Supporting parents and caregivers socially and emotionally with family-focused activities, policies, and education.
• Boys and Young Men: Protecting and promoting the physical, mental, and emotional health among people who identify as male.

Select your Top Choice:

Select your Second Choice:

Select your Third Choice:

Please select your most relevant experience as it relates to the Priority areas you selected above:

Community Outreach/Engagement

Subject Matter Expert

Personal Experience

Research/Evaluation/Data Analysis

Policy Advocacy/Creation

Grant Writing

Other

Other, please explain:

What makes you interested in participating in the Strategy Teams related to the priorities areas you selected?

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Time commitment
Two 4-hour in-person meetings
Two 1.5 hour virtual meetings
Review of written materials

Meeting schedule Date Ranges
Virtual meeting #1: Between December 2-13, 2019
In-person meeting #1: Between January 6-17, 2020
In-person meeting #2: Between February 3-14, 2020
Virtual meeting #2: Between March 2-6, 2020

For Meeting Schedule by Priority Area see attached PDF.

Attachment:Strategy Team Meeting Schedule.pdf

I confirm that I am able to attend and actively participate in all four Strategy Team meetings if I am assigned to the team.

If you are not able to attend the entire Strategy Team meetings, we will still keep you in the loop and have you review work that comes out of Strategy Team.

If you are not able to receive support from your employer to participate in our Strategic Planning process, you may be eligible to receive one of a limited number of stipends as compensation for your time and expertise.

Would you like to be considered for a stipend?

Yes

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What county do you live in?

How do you identify your race/ethnicity?

Black, African American, or African

American Indian, Native American, or Alaska Native

Asian American or Asian

Hispanic or Latino

White or Caucasian

Other

Prefer not to answer

Please further specify your race/ethnicity:

Ethiopian or Amharic

Oromo

Somali

Other Black, African American, or African

Prefer to not specify

If you answered 'Other', please specify:

Please specify your Tribal Affiliation (or leave blank if you prefer not to specify):

Please further specify your race/ethnicity:

Hmong

Vietnamese

Karen or Karenni, or other Burmese ancestry

Asian Indian

Other Asian American or Asian

Prefer not to specify

If you answered 'Other', please specify:

Please further specify your race/ethnicity:

Mexican

Puerto Rican

Other Hispanic or Latino

Prefer not to specify

If you answered 'Other', please specify:

Please further specify your race/ethnicity:

German

Irish

Norwegian

Other European or Caucasian ancestry

Prefer not to specify

If you answered 'Other', please specify:

If you selected 'Other', what is your race?

Do you identify with any of these communities?

LGBTQ

Parent of Child or Youth with Special Health Care Needs

Disability

Immigrant/Refugee

Adolescent/Young Adults

Father/Grandfather

Mother/Grandmother

Man

Woman

Do you identify with any other groups that you would like to see represented in one of these Strategy Teams?

Yes

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Please share:

We are grateful for your time and commitment to this important work. Thank you!

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.