1. How well do you understand the work and mission of the IITC? Very Much Pretty Well Somewhat Very Little Not at all

2. Check the area(s) of interest to your organization/community work?

3. Do you represent an IITC member/affiliate organization? Yes No NOt Sure

4. How long have you and/or your group had a working relationship with IITC? Less than 2 yrs 3-5 Yrs 6-10 Yrs 11-20 Yrs More Than 20 Yrs We have not had a working relationship

5. If you have had a working relationship, has IITC been able to provide assistance or support to your organization/community with any problems or concerns?  Yes No Not Sure

6. If yes, in what way was the IITC helpful? (check all that apply)

Training and mentorship for community member’s

Presentations and workshops

Participation in your local events, direct actions and/or campaigns

Youth mentorship/organizing

Providing you with information on important issues

Including your issues/struggles in United Nations interventions

Disseminating information about your issues/struggles

Building public support for your issues

Providing new contacts and opportunities

Increasing your understanding about human rights/Indigenous rights

Building your understanding about other Indigenous struggles

Building solidarity among Indigenous Peoples

Other:

7. Does your group work on issues that are: (check all that apply)

local regional national international

8. Which of the following methods do you prefer to receive information from the IITC?

9. Have you attended any of IITC’s annual treaty conferences? Yes No

If yes, how many have you attended? N/A 1-3 Years 4-8 Years 9-15 Years 16 or More

10. Do you have suggestions or comments that would help IITC to carry out its mission and to assist your community?

Thanks!

Name of Organization, Tribe, Community or Group

Name of person filling and out questionnaire and representation role in above group
(Director, Chair, representative, member, etc.):

Title Name

Address:

Line One

Appt/ Suite #

City

State

Zip Code

Country

Phone      Fax

E-mail Address