Data Reporting
Rapid Screens and Services Referred
State-Funded Grantee and Other Entities

Please complete the short survey to report screening data. If you have any questions or need any assistance, please contact:
Todd Stump at (651) 431-2359 or email at todd.stump@state.mn.us
 
Survey Questions
1. Your program:

Please select the answer that matches the first letter of your program's name. You will then get to select its name from a multi-choice list.

If your program name is not listed, please select the "other" option, and you will be provided a blank where you can enter the name.
 
 
 
1a. Your program's name begins with the letter A through C. Please select the name of your program from the list below.

If your program name is not listed, please select the "other" option, and you will be provided a blank where you can enter the name.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1b. Your program's name begins with the letter D through K. Please select the name of your program from the list below.

If your program name is not listed, please select the "other" option, and you will be provided a blank where you can enter the name.
 
 
 
 
 
 
 
 
 
 
 
 
 
1c. Your program's name begins with the letter L through O. Please select the name of your program from the list below.

If your program name is not listed, please select the "other" option, and you will be provided a blank where you can enter the name.
 
 
 
 
 
 
 
 
 
 
 
 
 
1d. Your program's name begins with the letter P through Z. Please select the name of your program from the list below.

If your program name is not listed, please select the "other" option, and you will be provided a blank where you can enter the name.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
dividing line
  Page 1/4