What is the name of your organization?

Phone Number

What is your email address?

How do you prefer to communicate? How do you prefer to communicate? Text Phone Call Email

Does your organization have Social Media accounts? If so, give handle: Does your organization have Social Media accounts? If so, give handle: Instagram Facebook LinkedIn

Do you have an existing health and wellness program? Do you have an existing health and wellness program? Yes No

If yes, have you been able to establish a fundraiser with your health and wellness program? If yes, have you been able to establish a fundraiser with your health and wellness program? Yes No

If no, are you interested in creating and supporting your community with bettering wellness through a fundraiser program? If no, are you interested in creating and supporting your community with bettering wellness through a fundraiser program? Yes (please continue) No. Thank you for taking a look at our program, you can close the window.

Do you have an existing health and wellness program? Do you have an existing health and wellness program? Yes No

How would you describe your current health and wellness program? How would you describe your current health and wellness program? Diabetes Prevention Program Wellness Coach and/or healthcare professional on staff Heart Health Program Monthly health programs Weekly health programs Once a year health fair Farmers Market Food Bank Never had a health program

How would you describe your program? How would you describe your program? Very Successful Moderately Successful Not Successful and want to get people engaged

When was your last health event? When was your last health event? Less than a month ago 2 - 6 months ago 6 months +

Does your organization have administration on board with having a wellness program, I.e., leadership, management? Does your organization have administration on board with having a wellness program, I.e., leadership, management? Yes No

Have your participants seen success within the program? Have your participants seen success within the program? Yes No

Are you currently in the National Diabetes Prevention Program (NDPP) as an organization? Are you currently in the National Diabetes Prevention Program (NDPP) as an organization? Yes No

Are you interested in the NDPP? Are you interested in the NDPP? Yes No

What are your top priorities or concerns for you organization?

What days are best for a Zoom Call if you are interested in our Health and Wellness Fundraiser? What days are best for a Zoom Call if you are interested in our Health and Wellness Fundraiser? Monday Tuesday Wednesday Thursday Friday Sunday

What time zone is your organization? What time zone is your organization? Eastern Central Mountain Pacific Hawaiian GMT

What timeframe is best for your Zoom? What timeframe is best for your Zoom? Mornings (10a - 12p) Afternoon (12p - 4p) Evening (4p - 7p)

Is there anything else you’d like for us to know before our Zoom?