Information submitted through this form will be used to create a jurisdictional scan form that will be shared with CPC directors and their affiliated networks. The name and email of the requestor submitted in this form will be shared in the jurisdictional scan to allow respondees to contact the requestor if needed. The jurisdictional scan forms can be shared to non-CPC members but will be password protected. All responses submitted through the response forms will be kept strictly confidential to the CPC and will not be made public.