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Agency*	State Health Department County Health Department Other Local Health Department or District Educational Institution Federal Public Health Agency Other Public Health Organization Other (Please enter below)
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Location / State*	New York City New York State except New York City New Jersey Not in United States Other State [Please Select] AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
I have worked in the public health field for:*	Less than 6 months 6 months to 2 years 2 to 5 years More than 5 years
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