Mid Design Phase Assessment
Please Select Your Institution
*
Please Select
Alabama A&M University
Alcorn State University
American Samoa Community College
Auburn University
Bay Mills Community College
Cankdeska Cikana Community College
Central State University
Clemson University
College of the Menominee Nation
College of the Muscogee Nation
Colorado State University Extension
Cornell University
Delaware State University
Florida A&M University
Fort Valley State College
Fort Peck Community College
Iowa State University
Institute of American Indian Arts
Kansas State University
Kentucky State University
Keweenaw Bay Ojibwa Community College
Langston University
Lincoln University
Louisiana State University
Michigan State University
Mississippi State University
Montana State University
Navajo Technical University
Nebraska Indian Community College
New Mexico State University
North Carolina A&T State University
North Carolina State University
North Dakota State University
Ohio State University
Oklahoma State University
Oregon State University
Pennsylvania State University
Prairie View A&M University
Purdue University
Red Lake Nation College
Rutgers University
Southern University
Tennessee State University
Texas A&M University
Tuskegee University
University of Arizona
University of Arkansas
University of Arkansas at Pine Bluff
University of California System
University of Connecticut
University of Delaware
University of Florida
University of Georgia
University of Hawaii
University of Idaho
University of Illinois
University of Kentucky
University of Maine
University of Maryland
University of Maryland Eastern Shore
University of Minnesota
University of Missouri
University of Nebraska
University of Nevada, Reno
University of New Hampshire
University of Rhode Island
University of Tennessee
University of Vermont
University of Wisconsin-Madison
University of Wyoming
Utah State University
Virginia Polytechnic Institute
Virginia State University
Washington State University
West Virginia State University
West Virginia University
Please choose your team from the dropdown.
Name
*
First Name
Last Name
Email
*
example@example.com
Which of the following EXCITE Design Phase Workshops have you attended or watched the recording? (check all that apply):
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EXCITE Design Phase Kick-off Event, September, 22, 2022
Partnerships and Priority Population, October 13, 2022
Budget and Finance, November 3, 2022
Adult Immunization in Your State, December 1, 2022
For the next set of questions, please rate your level of preparedness to:
Establish project goals for EXCITE implementation.
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Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
Connect and build a relationship with a public health partner, federally qualified health center, or rural health center.
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Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
Identify the priority population.
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Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
Identify vaccines relevant to the priority population.
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Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
Identify whom to contact in your state to provide vaccines to your priority population.
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Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
Include the required elements for the EXCITE Implementation budget.
*
Very well prepared
Somewhat prepared
Somewhat unprepared
Not at all prepared
In the text box below, please identify areas where you feel more assistance is needed.
Are you planning to apply for EXCITE Implementation competitive funding by March 15th, 2023?
Yes
No
Submit
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