RI Rural Health Transformation Program Interest Form

Thank you for your interest in staying connected and involved with Rhode Island's Rural Health Transformation Program (RHTP). To ensure we have your contact information for future distributions, please provide your information below and indicate how you would like to stay involved with RI's RHTP.

Additionally, the most up-to-date information can be found on RI's RHTP webpage: https://health.ri.gov/healthcare/rural-health-transformation-program.

Respondent Information

First Name*		Last Name*
Email*		Phone Number
Organizational Affiliation*
Title/Role*

Organization Information

Organization Name*
Organization Street*		Organization Street 2
Organization City*		Other City*
Organization State*		Organization Zip Code*

How would you like to stay involved in RI's RHTP?

Please indicate which communications you would like to receive (select all that apply):

* must provide value

Public meetings, listening sessions, and events

Funding opportunities and grants

Program design and implementation updates

Workforce and training initiatives

Data, reports, and needs assessments

Opportunities to provide input or participate in workgroups

General RHTP updates and announcements

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.