Annual Survey Year for the Survey(Required) Enter the year that this survey response represents.State(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingParent Organization(Required) Coalition Name(Required) Executive Director Name Executive Director Title Executive Director Email Executive Director PhoneCoalition Address Street Address Address Line 2 City State ZIP / Postal Code Coalition Website Facebook URL Twitter URL Year Established Mission StatementPolicy Focus and Program InitiativesCurrent Priorities Perinatal (e.g.,coverage,access,financing) overage,access,financing) Children (e.g., coverage,access,financing) Adults (e.g., coverage,access,financing) Aging population (e.g., coverage,access,financing) Public education Surveillance/Data Collection Early childhood caries Periodontal disease Oral cancer Infection control Injury Water fluoridation Dental sealants Fluoride varnish School-based dental care Tobacco prevention/cessation Expansion of safety net New workforce models Scope of practice Implementation of healthcare reform Medical/dental integration Medicaid adult benefit expansion/protection Medicare dental benefits State Oral Health/Public Health Programs Other (Please specify) Other Priorities Does your coalition engage in lobbying? Yes No If YesNone SelectedDirectGrassrootsBothBudgetary InfoIs your state CDC-funded? Yes No Is your coalition funded by your state's CDC grant? Yes No Does your coalition use an outside fiscal agent? Yes No Does your coalition have a fund-development plan? Yes No Are you willing to share your fund-development plan with other coalitions? Yes No Which of the following approaches has your coalition undertaken to generate funding? Federal grant development State grant development Community-level grant development Philanthropic grant development Corporate grant development Corporate sponsorships Coalition memberships Partnership marketing Online donations Large events Meeting attendance fees Monthly giving programs Other (please specify) Other Approaches Size of annual operating budget$500K and higher: $1,500$350K - $400K: $1,000$250K - $349K: $700$125K - $249K: $500$50K - $124K: $350$49K - and under: $200Does your organization conduct aFull financial auditFinancial ReviewNeitherRevenue Type 1GrantsIndividual DonationsCorporate SponsorshipsPrograms/event revenuePercent of Revenue 1Please enter a number from 1 to 100.Revenue Type 2GrantsIndividual DonationsCorporate SponsorshipsPrograms/event revenuePercent of Revenue 2Please enter a number from 1 to 100.Revenue Type 3GrantsIndividual DonationsCorporate SponsorshipsPrograms/event revenuePercent of Revenue 3Please enter a number from 1 to 100.Revenue Type 4GrantsIndividual DonationsCorporate SponsorshipsPrograms/event revenuePercent of Revenue 4Please enter a number from 1 to 100.How has your revenue changed over the past 1-3 years?IncreasedDecreasedStayed the sameOther, please specifyOther Revenue Change Coalition StructureTax Structure501(c)3501(c)4No Formal Tax StatusFull-Time StaffPart-Time StaffContract Employees? Yes No Contract Employee TypeDo you offer benefits to your paid staff? Yes No Upload Board Position Descriptions(Please avoid commas in filename)Max. file size: 100 MB.Upload Bylaws(Please avoid commas in filename)Max. file size: 100 MB.Committees? Yes No Committees ListDoes your coalition have affiliated regional coalitions? Yes No Does your coalition have a membership? Yes No Membership Dues? Yes No Do members have voting rights? Yes No Is membership open to anyone? Yes No Does your coalition have a membership application or criteria document? Yes No Upload Member Application Document(Please avoid commas in filename)Max. file size: 100 MB.PlanningDoes your coalition have a strategic plan? Yes No Upload Strategic Plan(Please avoid commas in filename)Max. file size: 100 MB.Does your coalition have a state advocacy plan or legislative action agenda? Yes No Upload Advocacy/Legislative Plan(Please avoid commas in filename)Max. file size: 100 MB.Does your state have a state oral health plan? Yes No Upload State Oral Health Plan(Please avoid commas in filename)Max. file size: 100 MB.Does your coalition help to develop and monitor implementation of the state oral health plan? Yes No Communications and ActivitiesTypes of communications modalities Press releases Paper newsletter Electronic newsletter or update Webinars In-person events Listserv Social Media Other Other Communications EvaluationDoes your coalition have a formal evaluation plan? Yes No Upload Evaluation Plan(Please avoid commas in filename)Max. file size: 100 MB.
