1. Please tell us about the various Linking Agent activities you've conducted this month. Mark all of the activies that apply, and provide an explanation of those activities.

Possible activities include:
Identifying a recognized area of need
Promoting the effort to address the need
Examining and defining the problem
Acquiring resources
Selecting an intervention
Supporting implementation
Extending on implementation
Renewing efforts

Please provide an explanation in the box below:

3. During the past month, based on a forty-hour workweek, what percentage of your time would you estimate that you spent working on Linking Agent activities? %

4. In your work, have you accessed any resources available through EMSTAC, including your TA Liaison? If so, please describe how these resources or assistance has been beneficial to your work.

6. What stage of the technical assistance process do you feel your district is in currently? Why?

8. What can EMSTAC do to assist you in meeting these goals?