Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

3b. Which of the following are reflected in your advisory group membership?MARK ALL THAT APPLY~ White~ Black or African American~ Hispanic or Latino~ Asian~ Native Hawaiian or other Pacific Islander~ American Indian or Alaska Native~ Gender diversity~ Sexual orientation diversity~ Religious diversity~ Persons with disabilities~ Geographic diversity~ Other, please specify _______________________________________________~ Don’t know~ None of the above~ Declined3c. How often does this community advisory body meet?~ Quarterly~ Semi-annually~ Annually~ Within the last two years~ Less regularly~ Other, please specify _______________________________________________~ Don’t know~ Declined3d. In what ways does your community advisory body assist you in providing services specifically forculturally and linguistically diverse groups?MARK ALL THAT APPLY~ Planning and designing culturally and linguistically appropriate health services~ Assessing community and clients’ needs~ Monitoring and evaluating quality of services~ Developing plans, protocols, and policies related to provision of services~ Providing input in other agency-wide policy formulation and development~ Other, please specify _______________________________________________~ Don’t know~ None of the above~ DeclinedCOSMOS Corporation, December 2003 4