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1. How long have you been involved with the Dine’ Ba’ Hozho Coalition, (including our previous name, Anti-Meth Task Force)? Note: Be sure to indicate months/years.
   
 
 
2. Our two main goals are: (1) increased collaboration surrounding health and wellness, and (2) decreased drug and alcohol use among teens in and around Shiprock. How well do our monthly meetings reflect each of these goals?
Not at all Somewhat Very much so
Collaboration
Decreased drug and alcohol use among teens
 
 
 
3. Do you support our meeting format? (Please write yes or no in the box, and any suggestions you might have.)
   
 
 
 
4. Are you aware that you can call or email the “core team” anytime with suggestions and comments?
 
Yes
 
No
 
 
 
5. Right now the “core team” votes on important decisions related to funding and changes in strategies. Do you support this system?
 
Yes
 
No
 
Unsure - would like more information
 
 
 
6. Positive Community Norms (MOST of Us®) is one strategy of the Coalition. Do you have enough information on how this initiative works?
 
Yes
 
Somewhat
 
No
 
 
 
7. Do you believe the larger community in Shiprock is favorable about having Positive Community Norms in the schools and in the community?
 
Yes
 
Somewhat
 
No
 
Need more information
 
 
 
8. Would your organization be willing to sign an updated “Memorandum of Understanding” so that we can formally show your support to our funders?
 
Yes
 
No
 
Unsure
 
 
 
9. Please check all that apply, to identify who you represent when you share your opinions at our meetings:
 
schools
 
private business
 
government (US or Tribal)
 
behavioral health
 
prevention
 
higher education
 
housing
 
senior citizens
 
youth
 
veterans
 
youth serving organization
 
employment support
 
health and wellness
 
medical
 
parents
 
law enforcement
 
Other
 

 
 
 
10. How much do you support having a “strategic planning” session with a facilitator from outside the Shiprock area?
 
Not at all
 
Somewhat
 
Very much so
 
Unsure - would like more information
 
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