NECHE
The New England Coalition for Health Equity
SURVEY OF COMMUNITY BASED ORGANIZATIONS OF THE NEW ENGLAND REGION
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1.Date 2.Name of organization 3a.address   3b.City   3c.State   3d.Zip   4a.Phone   4b.Extension   5.Name of Person Completing Survey 6.Position/Title of Person Completing Survey 7.What Year was the Organization Established ? 8.Did your organization go through a strategic planning process in the last three years ? Yes No Don't Know Refused 9.If Yes in question 8, how long did it take ? 10.What is your organization's mission statement ?	11 How Many paid employees and other personnel does the organization have ?(please indicate the number) 1 Full Time 3 Part Time 2 Trainee/Interns/Students 4 Volunteers 12 Please indicate the languages in which you provide services ? (Check all that apply) 1 English 2 French 3 Haitian Creole 4 Spanish 5 Portuguese 6 Khmer 7 Vietnamese 8 Cantonese 9 Mandarin 10 Russian 11 Bosnian 12 Somali 13 Other   Specify 14 Don't Know 15 Refused 13 What were the annual operating revenues of the organization for the most recently completed fiscal year ?   14.Did you have a deficit ? Yes No Don't Know Refused