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Email address
First Name
Last Name
Organization
Role
What is the primary service sector/system you represent given your role listed above?
Select one
Social Services - Housing
Social Services - Employment/workforce development
Social services - Basic needs/poverty
Social Services - Youth or family services
Culturally specific, immigrant & refugee services
Healthcare - Clinic
Healthcare - Hospital
Healthcare - School based health centers
Public Health - Home visiting
Public health - Other programs
Public health - Environmental health
Treatment - Community mental health
Treatment - BH/MH in private practice
Treatment - Substance use
Education - Early learning/childhood
Education - K-12
Education - Higher education
Law Enforcement
Judicial - Courts
Corrections
Advocacy Services (e.g., CASA, victim's assistance)
Peer Delivered Services - In substance abuse/recovery
Peer Delivered Services - In behavioral health/mental health
Peer Delivered Services - In youth or family services
DHS - Child welfare
DHS - Self-sufficiency
DHS - Aging and disability services
Faith-based
Charitable Giving - Foundations
Business - For profit
Government - Local, state, federal, or tribal
Other
What region do you serve?
Select one
Willamette Valley
Metro-Portland Tri-County
Northern Coast
Southern Coast
Columbia Gorge
Southern Oregon
Central Oregon
Eastern Oregon
Statewide
Other Region
Are the services offered at your organization culturally specific
Yes
No
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