Needs Assessment Survey
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Your input provides the guidance for future educational activities that meet your needs.
We thank you for your participation!
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This survey is also available in a printable, PDF format.
Click here.
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| Name:
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| Credentials:
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| Occupation/Profession:
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| If selected "Other", please specify:
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| Area of Specialization:
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| Years in Practice:
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| Age:
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| What is your time zone?
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| Primary Practice Facility:
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| Address of Primary Practice Facility:
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| City:
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| State/Province:
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| Zip:
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| Fax:
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| E-mail:
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Type of
Facility
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| If selected "Other", please specify:
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| Please identify topics/programs that
Trinity Healthforce Learning should produce in the upcoming year to help meet
your needs. Give as much detail as possible by describing the problem or
challenge and what key points you would like to see covered in the program.
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| Topic/Program recommendation:
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| Describe Problem and/or give key points to
address:
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| Topic/Program recommendation:
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| Describe Problem and/or give key points to
address:
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| Topic/Program recommendation:
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| Describe Problem and/or give key points to
address:
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| Describe your average work day. Include any
challenges that you must overcome on a regular basis. This information will be
used to provide "real world" examples in educational activities.
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| Does your state mandate specific continuing
education topics for relicensure?
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| If yes, please list topics and time
requirements?
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| How soon will you be obtaining your continuing
education credits online?
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| Will you/do you primarily go online
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| If selected "Other", please specify:
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The speed of my primary means of Internet access is:
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| If selected "Other", please specify:
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| What is your preferred format to receive Internet-based/online
continuing education?
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| When using Internet-based/online activities
for continuing education, how much time are you able to spend at one sitting?
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| Which day of the week do you prefer to
participate in live CE activities?
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| To meet your continuing education needs, live
events should start:
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| Which method do you prefer for content
reinforcement?
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| If selected "Other", please specify:
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What is your preference for the length of a live or
videotaped presentation?
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*(with supplemental reading materials) |
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If selected "Other", please specify:
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Please rank your top 5 choices with 1 being your first
choice on how you prefer to participate in continuing education
activities.
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First
Choice:
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Second Choice:
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Third
Choice:
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Fourth Choice:
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Fifth
Choice:
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Have Trinity Healthforce Learning Continuing Education
programs positively impacted your professional practice?
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How can we be more helpful in your educational endeavors?
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Are there any other comments you would like to share with us?
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Thank you for taking the time to complete this survey.
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