Creating a Healthier Mississippi One Community at a Time!
Dear Mississippi Resident:
We are gathering information about the health of residents in the state. This survey is conducted by Project CHANGE, in partnership with Caffee, Caffee and Associates Public Health Foundation, Inc., Claiborne County Board of Supervisors, Delta Health Alliance, Fellowship of Hope Community Church, and Mississippi State University. Project CHANGE is supported in part a Community Transformation Grant awarded to My Brother’s Keeper, Inc from the Centers for Disease Control and Prevention (Cooperative Agreement Number: 1U58DP003711).
We would like to ask some questions about health and health practices. You do not have to answer any question you do not want to. Your participation is completely voluntary. If you decide not to participate in this survey, this will not affect any relationship you may have with My Brother’s Keeper, Inc or any of our partners. All the information that you give us will be kept in the strictest confidence. Your name will not be attached to any of your answers.
For participating in this project, we will raffle off ten $100 gift cards as well as provide a monetary award to the county that has the most returned surveys to start or expand a farmers market.
By completing this survey, you agree to take part in this health assessment and to follow the instructions given within the survey. In addition, you consent to allow us to use the information you provide in reports, publications or presentations. Your name will not be used in any reports, publications or presentations that use the information from this survey. Please select the best response for each given question.
Thank you for your time and consideration to improve health here in Mississippi! If you have any questions regarding the survey, contact Dantrell Simmons at 601.957.7710 ext 102.
My Brother’s Keeper, Inc.
In partnership with:
*Caffee, Caffee and Associates Public Health Foundation, Inc.
*Claiborne County Board of Supervisors
*Delta Health Alliance
*Fellowship of Hope Community Church
*Mississippi State University