Survey - Eating Disorders Awareness Week 2023 Collaborator Sign-Up

1.

Contact and Demographic Information

*

Name:

Title	First Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

Phone Number:

Thank you for registering, you will now receive periodic updates and communications from National Eating Disorders Association.

Yes, I would like to receive postal mail from National Eating Disorders Association

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*2.

Question - Required - What is the name of your organization?

*3.

Question - Required - What is your organization's website or URL link? (Please enter carefully as the link to your organization will be posted for public view)

*4.

Question - Required - Please select the closest description of your organization.

5.

Question - Not Required - If you selected 'Other' in question 4, please let us know which type of organization you are representing:

*6.

Question - Required - Is this your organization's first time participating in Eating Disorders Awareness Week? (Please note that previous years, we identified collaborators as partners.)

7.

Question - Not Required - If you selected 'No' to question 6, please indicate the number of years you have participated, excluding this year's collaboration.

1-2

3-5

6-10

11+

*8.

Question - Required - We want to know what participants are doing! Please indicate the way(s) that your organization will be participating.
Please make between 1 and 6 selections from the choices below.

	Sharing the Online ED Screening Tool in organizational emails
	Re-evaluating organizational policies and resources to include eating disorder information
	Providing informational materials such as posters, pamphlets or fact/statistics sheets
	Organizing an event or activity (either online or in your community)
	Posting eating disorder information on social networking site(s)
	Encouraging my organization's members/constituents to do at least one thing to raise awareness
	Other

9.

Question - Not Required - If you answered 'Other' to question 8, please indicate how your organization plans to participate.

*10.

Question - Required - Please indicate how your organization heard about Eating Disorders Awareness Week.

11.

Question - Not Required - If you answered 'Other' to question 10, please indicate how your organization heard about Eating Disorders Awareness Week.

12.

Question - Not Required - Who is your anticipated audience demographic(s)?
Please make between 1 and 9 selections from the choices below.

	Students
	Educators
	Health Care Professionals
	Mental Health Professionals
	Government Officials
	Staff within my organization
	Community members
	General Public
	Other

13.

Question - Not Required - If you answered 'Other' to question 12, please indicate who your anticipated demographic(s) will be.

14.

Question - Not Required - What is your anticipated reach (# of people)?

*15.

Question - Required - Please select 'Yes' to indicate that your organization has agreed for their name and website information to be publicly posted on the Eating Disorders Awareness Week 2023 website. A 'No' selection will result in your organization's participation to be private and undisclosed to the public.