Form Policy Academy Bas Policy Academy Bas Policy Academy Baseline

OMB No. 0930-0316

Expiration Date: XX/XX/XXXX

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Policy Academy Baseline

Introduction

Thank you for participating in the Policy Academy. The questions in this baseline survey will help us better prepare for the Policy Academy and understand how we can best support all of our participants.

Personal Information

Q1. Participant name:

Q2. Participant email:

Q3. Participant organization:

Content

Q4. Please rate your level of knowledge related to supporting the adoption of policy.

• Not knowledgeable (1)

• Slightly knowledgeable (2)

• Somewhat knowledgeable (3)

• Very knowledgeable (4)

• Extremely knowledgeable (5)

Q4.1. Please provide any additional details about your knowledge related to supporting the adoption of policy.

Q5. Please rate your confidence level related to supporting the adoption of policies.

• Not confident (1)

• Slightly confident (2)

• Somewhat confident (3)

• Very confident (4)

• Extremely confident (5)

Q5.1. Please provide any additional details about your confidence level related to supporting the adoption of policies.

Q6. Please rate your skill level related to supporting the adoption of policies.

• Not skilled (1)

• Slightly skilled (2)

• Somewhat skilled (3)

• Very skilled (4)

• Extremely skilled (5)

Q7. What skills do you currently have that will aid in your ability to navigate the policy process?

Q8. What are you looking to get out of the Policy Academy?

Resources and Support

Q9. What resources do you currently have that will aid in your ability to navigate the policy process?

Q10. To what extent do members in your community support your coalition's alcohol policy efforts?

Q11. What barriers to the policy process do you expect to face in your community?

Q12. What barriers to the policy process do you expect to face from local and state decision makers?

Q13. What changes do you hope to see in the community environment as a result of your coalition's policy work?

Q14. Please describe how attending the Policy Academy might advance your coalition work.

Thank You Page

We thank you for your time spent taking this survey. Your response has been recorded.