Health Educator Readiness Assessment Survey
Name
*
First Name
Last Name
Email
*
Required Ex: example@example.com
Phone Number
Optional
Format: (000) 000-0000.
Organization, if applicable
1. Do you currently work as part of a community organization or have partners who can help with recruiting and outreach?
Yes
No
a. How long have you been working together?
Ex: "2 years" or "2022"
b. Have you collaborated with this organization/partner to implement programs before?
Yes
No
c. Does the organization/ partner offer food distribution on site?
Yes
No
2. Do you have a grant or funds available to support the program?
Yes
No
a. How much?
a. Are you interested in scholarship opportunities?
Yes
No
3. Do you have experience leading nutrition education classes?
Yes
No
4. Do you have experience leading cooking demonstration recipes?
Yes
No
5. Do you have experience facilitating support groups?
Yes
No
6. When do you plan to start a program?
Within the next 3- 6 months
Within the next 6-12 months
Not sure
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