This form should take about 5 minutes to complete. This will help us learn more about you, the types of CVIPI information that you hope to access through this National CVIPI Resource and Field Support Center and how you’d like to best access this information. Thank you for sharing your responses, we appreciate your feedback.

Which types of organizations do you have ongoing formal partnerships with (formal meaning where you work together on a project, may have an MOU, meet as part of a steering committee, etc.)? Please check all that apply.

Public partnership (federal, state, local government executive branch, i.e. mayor's office)Law Enforcement (local/county police)Other criminal justice organizations (courts, probation, parole, attorney general, district attorney, etc.)

Public Health Organizations (hospitals, public health agencies, mental/substance abuse partners, etc.)Local SchoolsResearch PartnersNational community-based partners (community development corporations, Boys & Girls clubs, YMCA's)Local community-based partners (local CVIPI organization, job training center, etc.)Other

If other, please specify:

What barriers, if any, have you faced to access CVIPI funding? Please check all that apply.

Size of my organizationOrganizational requirements made by the funder (e.g. 501c3 status, auditing requirements, board requirements, obtaining a Unique Entity Identifier)Data requirements made by the funder (impact of efforts, requirements for evidence-base strategies, etc.)Other

If other, please specify:

Can we share your organizational information with other agencies that have joined the CVIPI Community of Practice (agency name, state and primary CVI work ONLY)?

YesNo

Can we add you to our regular updates where we will be sharing CVI related events, conferences, training opportunities, funding availability, webinars, and other community of practice peer sharing events?

YesNo

Community Based Violence Intervention and Prevention (CVIPI)