Share Your Story

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Space Cell

Less than 10%

Greater than 75%

I am not sure

Hispanic or Latino

American Indian or Alaska Native

Black or African American

Native Hawaiian or Other Pacific Islander

How has the ACE TA Center helped you with health insurance enrollment?

We want to know how you or your organization have used tools and information from the ACE TA Center to enroll RWHAP clients in health insurance. We’d also like to hear what other tools would help you. We will use this information to develop future resources, and peer learning opportunities.

1. Have you ever attended an ACE TA Center webinar? *This question is required.

2. Have you ever used an ACE TA Center tool (e.g., enrollment tracking worksheet, special enrollment period fact sheet), available on the TARGET website, for your organization's enrollment efforts? *This question is required.

3. Briefly share with us (in a few sentences) a story about how you or your organization used information/tools from the ACE TA Center to help enroll clients living with HIV. If you used an ACE TA Center resource to reach a particular target population (e.g., clients of a particular cultural or ethnic group, age group, or gender), please describe the population. *This question is required.

4. What other tools and resources would be helpful in your enrollment work? In the future, how best can the ACE TA Center help you? *This question is required.

5. Please provide your contact information. The ACE TA Center may contact you with additional questions or to see if you’re comfortable sharing your story with other grantees and providers.

First Name *This question is required.

Last Name *This question is required.

Organization Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

6. Please estimate the percentage of RWHAP clients of color (i.e., minority clients) served by your HIV program (including your contracted service providers) that fall into in each of the following categories. The total may add up to more than 100% (check one percentage on each row).