Organization Main Contact (Name, Position, Email) *
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Organization's Website
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Date of Request (Today's Date) *
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The Social Determinants of health are the economic and social conditions that influence individual and group differences in health status. Which of the Social Determinants of Health does your organization address? Check all that apply. *
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How did you find out about CTAC? *
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Are you looking to collect data? *
Are you looking to analyze existing data? *
Please describe your organization's data and evaluation needs.
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What are the deliverables you are hoping CTAC can give your organization?
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What is the expected time length of this project? When are you looking to start and finish?
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Do you have needs beyond data evaluation that you'd like to talk to the Ginsberg Center about?
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