Region 1 NCRHTP Stakeholder Engagement Form

Thank you for your interest in engaging with and providing feedback for the Region 1 NC ROOTS Hub! Click here to learn more about NC Rural Health Transformation Program, the role of the NC ROOTS Hubs, and which region your county is in.

Name

First NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Agency

If submitting as an individual, enter "community member"

Title (if applicable)

If submitting as an individual, enter "community member"

County/counties or area that your agency serves or that you represent

All Region 1 counties and areas are in this list. Select all that apply.

NCRHTP core initiatives - please choose all areas of interest/expertise

How would you like to engage with NCRHTP in WNC?

Other

Is there anything else you'd like to share about your interest in being connected with NCRHTP in WNC?

Please provide any feedback about NCRHTP implementation in WNC.

Stevens Amendment Disclosure: This Stakeholder Engagement Form is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $213,008,356.47 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.