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Instructions
| Instructions to Complete "National Initiative to Address COVID-19 Public Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities" Work Plan | | | | | | | | | |
| This workbook contains macros. Please enable the macros by clicking on "Enable Content" to ensure the workbook functions properly. | | | | | | | | | |
| Overall Instructions | | | | | | | | | |
| This file consists of seven worksheets (i.e., tabs across the bottom) you will use to complete your workplan: an instructions tab, cover sheet tab and strategy tabs. Each possible strategy from the NOFO has its own worksheet. | | | | | | | | | |
| Worksheet Instructions | | | | | | | | | |
| Cover sheet: Enter applicant name and the date this file is submitted. | | | | | | | | | |
| Worksheets Numbered 1-5: Complete the sections for strategies you propose implementing with the grant funds. If you are not proposing to implement a particular strategy, you can leave that worksheet blank. Strategies and activities should be based on local needs and priorities. See below for instructions on what to enter for each section. | | | | | | | | | |
| Strategy Description | Corresponding strategy description from NOFO (provided for you) | | | | | | | | |
| NOFO Outcome(s) Addressed | Select which outcome(s) this strategy will work to achieve (Select all that apply) | | | | | | | | |
| Other Outcomes | Enter other outcomes that the strategy addresses if not captured in the NOFO outcomes (optional) | | | | | | | | |
| Data Source(s) Used to Identify Population(s) of Focus | Describe how you identified your populations of focus for this strategy - e.g., surveillance systems or other data sources, health assessments | | | | | | | | |
| Estimated Amount of Funding Allocated to Strategy | | | | | | | | | |
| (% of Total Funding and Dollar Amount) | Enter the percentage of total funding and dollar amount allocated to implement this strategy | | | | | | | | | |
| In order to achieve the outcome(s) proposed above, you will implement one or more activities. Include each activity in the worksheet tables with the following information. Add additional activity tables as needed. | | | | | | | | | |
| Activity 1 Title | Enter a brief title for the activity | | | | | | | | |
| Activity Focus | Select a focus area for the activity (Note: the drop down provided indicates the priority activity for the strategy as stated in the NOFO) (Select one) | | | | | | | | |
| Other Activity Focus | Enter other focus area for the activity if not captured in the provided drop down | | | | | | | | |
| Racial and Ethnic Population(s) of Focus | Select the specific racial and ethnic populations who you will be serving with this activity (if applicable) (Select all that apply) | | | | | | | | |
| Other Population(s) of Focus | Select other populations of focus who you will be serving with this activity (if applicable) (Select all that apply) | | | | | | | | |
| Other Population | Enter any additional population(s) of focus for the activity if not captured in the provided drop down | | | | | | | | |
| Estimated Reach of Population(s) of Focus | Enter the estimated number of people who will be reached. If you selected more than one population type, please provide the reach by each population (e.g., Asian: 100,000, Rural 25,000). | | | | | | | | |
| Geographic Area | Select where this activity will be implemented (Select one) | | | | | | | | |
| Setting | Select the type of setting in which the activity will take place (Select one) | | | | | | | | |
| Other Setting | Enter other setting for the activity if not captured in the provided drop down | | | | | | | | |
| Activity Description | | | Contributing Partners | Partner Type | Other Partner Type | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date |
| Describe the activity you will implement in support of the strategy. Please include a description of the problem the activity will address (e.g., structural barriers), what you will do to address the problem (e.g., policy change), and the process for implementing the activity. Also include key milestones to be achieved during the project period. | | | | | | | | | |
| | | Name the contributing partner in support of this activity, if any | Select type of contributing partner (Select one) | Enter other partner type for the activity if not captured in the provided drop down | Name key contracts or consultants in support of this activity, if any | Indicate deliverables/ outputs expected from this activity | Indicate the anticipated activity start date | Indicate the anticipated activity end date | |
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Cover Sheet
| National Initiative to Address COVID-19 Public Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities |
| CDC-RFA-OT21-2103 Work Plan Template |
Recipient Name:
Submission Date:
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(Strategy 1)Resources Services
| Strategy Description | 1. Expand existing and/or develop new mitigation and prevention resources and services to reduce COVID-19-related disparities among populations at higher risk and that are underserved |
| NOFO Outcome(s) Addressed | |
(Select all that apply)
| Other Outcome(s) (as identified by applicant) |
| Data Source(s) Used to Identify Population(s) of Focus |
| Estimated Amount of Funding Allocated to Strategy |
(% of Total Funding and Dollar Amount)
| Activity 1 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 2 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 3 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 4 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 5 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | |
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(Strategy 2)Data Improvement
| Strategy Description | 2. Increase/improve data collection and reporting for populations experiencing a disproportionate burden of COVID-19 infection, severe illness, and death to guide the response to the COVID-19 pandemic |
| NOFO Outcome(s) Addressed | |
(Select all that apply)
| Other Outcome(s) (as identified by applicant) |
| Data Source(s) Used to Identify Population(s) of Focus |
| Estimated Amount of Funding Allocated to Strategy |
(% of Total Funding and Dollar Amount)
| Activity 1 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 2 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 3 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 4 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 5 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
&1#&"Calibri"&10&K000000Restricted Use/Any User (No encryption)
(Strategy 3) Infrastructure
| Strategy Description | 3. Build, leverage, and expand infrastructure support for COVID-19 prevention and control among populations that are at higher risk and underserved |
| NOFO Outcome(s) Addressed | |
(Select all that apply)
| Other Outcome(s) (as identified by applicant) |
| Data Source(s) Used to Identify Population(s) of Focus |
| Estimated Amount of Funding Allocated to Strategy |
(% of Total Funding and Dollar Amount)
| Activity 1 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 2 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 3 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 4 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 5 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
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(Strategy 4) Mobilize Partners
| Strategy Description | 4. Mobilize partners and collaborators to advance health equity and address social determinants of health as they relate to COVID-19 health disparities among populations at higher risk and that are underserved |
| NOFO Outcome(s) Addressed | |
(Select all that apply)
| Other Outcome(s) (as identified by applicant) |
| Data Source(s) Used to Identify Population(s) of Focus |
| Estimated Amount of Funding Allocated to Strategy |
(% of Total Funding and Dollar Amount)
| Activity 1 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 2 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 3 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 4 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 5 Title |
| Activity Focus |
(Select one)
| Other Activity Focus (if applicable) |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
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(5)Other
| Strategy Description | 5. Other strategy - insert description |
| NOFO Outcome(s) Addressed | |
(Select all that apply)
| Other Outcome(s) (as identified by applicant) |
| Data Source(s) Used to Identify Population(s) of Focus |
| Estimated Amount of Funding Allocated to Strategy |
(% of Total Funding and Dollar Amount)
| Activity 1 Title |
| Activity Focus |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 2 Title |
| Activity Focus |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 3 Title |
| Activity Focus |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 4 Title |
| Activity Focus |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
| Activity 5 Title |
| Activity Focus |
| Racial and Ethnic Population(s) of Focus |
(Select all that apply) Other Population(s) of Focus (Select all that apply)
| Other Population (if applicable) |
| Estimated Reach of Population(s) of Focus |
| Geographic Area |
(Select one) Setting (Select one)
| | Other Setting (if applicable) | | | | |
| | Activity Description | | | Contributing Partners | Partner Type |
| (Select one) | Other Partner Type | | | | | |
| (if applicable) | Key Contracts & Consultants | Key Deliverables/ Outputs | Start Date | End Date | | |
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ResponseOpts
| Below are response options for applicable Work Plan template categories. | | | |
| Outcomes | | | |
| Reduced COVID-19-related health disparities | | | |
| Improved and increased testing and contact tracing among populations at higher risk and that are underserved, including racial and ethnic minority groups and people living in rural communities | | | |
| Improved state, local, US territorial and freely associated state health department capacity and services to prevent and control COVID-19 infection (or transmission) among populations at higher risk and that are underserved, including racial and ethnic minority groups and people living in rural communities | | | |
| Activity Focus Areas - Strategy 1 | Activity Focus Areas - Strategy 2 | Activity Focus Areas - Strategy 3 | Activity Focus Areas - Strategy 4 |
| Expand testing and contract tracing (priority) | Improve data collection and reporting for testing and contract tracing (priority) | Expand the infrastructure to improve testing and contact tracing (priority) | Build community capacity to reach disproportionately affected populations with effective culturally and linguistically tailored programs and practices (priority) |
| Vaccine coordination, quarantine and isolation options, and preventive care and disease management | Build on plans for collecting and reporting timely, complete, representative, and relevant data | Establish, enhance, or implement leadership-level health equity offices, workgroups, task forces, or positions | Build and implement cross-sectoral partnerships to align public health, healthcare, and non-health (e.g., housing, transportation, social service) interventions |
| Tailor and adapt evidence-based policies, systems, and environmental strategies | Develop strategies to educate providers, community partners, and programs | Convene and facilitate multi-sector coalitions or advisory groups | Develop mechanisms such as community advisory groups |
| Identify and establish collaborations with critical partners | Develop and implement plans to disseminate health equity-related data and related materials tailored to be culturally and linguistically responsive | Update jurisdictions’ COVID-19 plans and health equity plans | Develop and disseminate culturally and linguistically responsive COVID-19 prevention communications |
| Other - please specify | Develop key principles and resources for collecting, analyzing, reporting, and disseminating health equity-related data | Build and expand an inclusive public health workforce | Build community capacity that includes traditional organizations (e.g., public health, healthcare) and non-traditional partners |
| Assure adequate resources for data infrastructure and workforce | Other - please specify | Identify and establish collaborations with critical partners affiliated with and who provide services to populations that are underserved and at higher risk for COVID-19 |
| Other - please specify | | Other - please specify |
| Populations of Focus | Racial and ethnic minority populations |
| People living in rural areas | Black or African American |
| People experiencing homelessness | Hispanic or Latino |
| People who are incarcerated | American Indian/Alaska Native |
| People with disabilities | Asian |
| People with substance use disorders | Native Hawaiian and Pacific Islanders |
| Non-U.S. born persons | Activity does not address racial and ethnic minority populations |
| Religious minority | |
| Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons | |
| People living in other congregate housing (not legally bound) | |
| Other - please specify | |
| Activity does not address other underserved populations | |
| Geographic Areas | |
| Rural | |
| Urban | |
| Both | |
| Setting |
| Childcare center/schools |
| Community-based organization |
| Correctional facilities and institutions |
| Faith-based organization (e.g., places of worship) |
| Home |
| Local health department |
| Medical or clinical site (e.g., hospitals) |
| Recreational facility |
| Senior residence or long term care facilities |
| Shelters/group homes |
| State health department |
| Tribal nation or area |
| University or college |
| Worksite |
| Other - please specify |
| Partner Types |
| Academic institutions |
| Asian American and Pacific Islander Serving Institution |
| Business, corporation, or industry |
| Community-based and civic organizations |
| Correctional facilities and institutions |
| Faith-based organizations |
| Governmental organizations focused on non-health services |
| Healthcare providers |
| Health-related organizations (e.g., pharmacies, testing centers, community health workers) |
| Local governmental agencies and community leaders |
| Non-governmental organization |
| Rural health clinics and critical access hospitals |
| Schools/school districts |
| Social services providers |
| State offices of rural health or equivalent |
| Tribes, tribal organizations |
| Other - please specify |
&1#&"Calibri"&10&K000000Restricted Use/Any User (No encryption)
