MC4JR Partnership Snapshot, F-03050 (06/2022)

The Partnership Snapshot is a tool for your project/organization to share updates related to the MC4JR grant throughout the grant period. These updates can be shared with your Community Liaison (Lilli Minor or LaTonya Hughes) during Office Hours or brief meetings if you prefer. Overall, your Community Liaison hopes to connect with you a few times to discuss this information throughout the grant period. If you do not have information to share at this moment, please feel free to fill out this survey at another time.

1. What organization are you from? *This question is required.

We would like to know the timeframe for the information you are providing in the next two questions.

2. What is the start date for the information you are providing? *This question is required. This question requires a valid date format of MM/DD/YYYY.

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3. What is the end date for the information you are providing? *This question is required. This question requires a valid date format of MM/DD/YYYY.

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4. If your project/organization has developed any new or deepened community partnerships around your project focus during the timeframe you have specified, please list those on the table below.

Note: we are defining a "new" partner as one with which you did not have a previously established relationship. We are defining a "deepened" partner as one with whom you are continuing to work in a strengthened or expanded capacity.

5. If there are any project challenges you would like to share (pertaining to partnerships, progress, etc.), please do so below. (Optional)

6. If there are any project successes or highlights you would like to share (pertaining to partnerships, progress, etc.), please do so below. (Optional)

7. Do you have any questions or need support as it relates to the MC4JR grant? If so, please list them below and someone from the MC4JR grant team will reach out to you in response. (Optional)

Space Cell	Number of New Partnerships	Number of Deepened Partnerships
Academic Institutions	Academic Institutions: Number of New Partnerships	Academic Institutions: Number of Deepened Partnerships
Asian American and Pacific Islander-Serving Institution	Asian American and Pacific Islander-Serving Institution: Number of New Partnerships	Asian American and Pacific Islander-Serving Institution: Number of Deepened Partnerships
Community-based and civic organizations	Community-based and civic organizations: Number of New Partnerships	Community-based and civic organizations: Number of Deepened Partnerships
Correctional facilities and institutions organizations	Correctional facilities and institutions organizations: Number of New Partnerships	Correctional facilities and institutions organizations: Number of Deepened Partnerships
Faith Based Organizations	Faith Based Organizations: Number of New Partnerships	Faith Based Organizations: Number of Deepened Partnerships
Healthcare providers	Healthcare providers: Number of New Partnerships	Healthcare providers: Number of Deepened Partnerships
Health-related organizations	Health-related organizations: Number of New Partnerships	Health-related organizations: Number of Deepened Partnerships
Local governmental agencies and community leaders	Local governmental agencies and community leaders: Number of New Partnerships	Local governmental agencies and community leaders: Number of Deepened Partnerships
Nongovernmental organizations	Nongovernmental organizations: Number of New Partnerships	Nongovernmental organizations: Number of Deepened Partnerships
Rural health clinics and critical access hospitals governmental organizations focused on non-health services	Rural health clinics and critical access hospitals governmental organizations focused on non-health services: Number of New Partnerships	Rural health clinics and critical access hospitals governmental organizations focused on non-health services: Number of Deepened Partnerships
Schools/school districts	Schools/school districts: Number of New Partnerships	Schools/school districts: Number of Deepened Partnerships
Social services providers and organizations, including those addressing social determinants of health	Social services providers and organizations, including those addressing social determinants of health: Number of New Partnerships	Social services providers and organizations, including those addressing social determinants of health: Number of Deepened Partnerships
State offices of rural health or equivalent, state rural health associations	State offices of rural health or equivalent, state rural health associations: Number of New Partnerships	State offices of rural health or equivalent, state rural health associations: Number of Deepened Partnerships
Tribes, tribal organizations	Tribes, tribal organizations: Number of New Partnerships	Tribes, tribal organizations: Number of Deepened Partnerships
State Health department	State Health department: Number of New Partnerships	State Health department: Number of Deepened Partnerships
Local health department	Local health department: Number of New Partnerships	Local health department: Number of Deepened Partnerships
Council, community group, coalition or other working group	Council, community group, coalition or other working group: Number of New Partnerships	Council, community group, coalition or other working group: Number of Deepened Partnerships
Mental or behavioral health	Mental or behavioral health: Number of New Partnerships	Mental or behavioral health: Number of Deepened Partnerships
Federal agency (other than CDC)	Federal agency (other than CDC): Number of New Partnerships	Federal agency (other than CDC): Number of Deepened Partnerships
Corporation, industry or private sector	Corporation, industry or private sector: Number of New Partnerships	Corporation, industry or private sector: Number of Deepened Partnerships
Individual community members	Individual community members: Number of New Partnerships	Individual community members: Number of Deepened Partnerships
Enter another option	Other: Number of New Partnerships	Other: Number of Deepened Partnerships