Request a Scan

Request a Jurisdictional Scan

Privacy and Access Disclosure

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.

Note: All jurisdictional scan requests will be considered, but will approved or declined by the CPC board based on relevancy to all jurisdictions


Scan Questions

The following questions will automatically be included in your scan:

  • What is something positive or working well regarding [this topic]?
  • What is something not working, or causing stress regarding [this topic]?
  • What is an idea that can be explored further regarding [this topic]?
  • Does your agency/organization have specialists dedicated to [this topic]? If yes, please provide their contact information.

Provide up to 5 additional question(s) you would like answered in the scan:

- Question formats available include: free text, multiple choice, checkboxes, number scale

- To increase response completion, we encourage you to minimize the amount of free-text responses
Click or drag files to this area to upload. You can upload up to 10 files.
If you have any issues uploading you document, please email