1. Please submit your contact information to enable the scheduling of a program which you desire to be given.

2. There are numerous programs available through Purdue Cooperative Extension. Please indicate below which program areas would be of interest to you and your clients. A (1) would be a low priority and a (5) would be a high priority.

  (1) Very Low Interest (2) Low Interest (3) A Possibility (4) High Interest (5) Very High Interest
Human Resources (i.e. financial literacy, resource management, home care)
Food & Nutrition (i.e. nutrition, food safety, food preservation)
Human Development (i.e. parenting, child development, aging)
Health (i.e. safety, Alzheimer's disease)

3. What time of day would best meet your programming needs? (Select all that apply.)

4. What special considerations does the population you work with have? (Select all that apply.)

5. What day of the week would work best for your clients? (Check all that apply.)

6. Purdue Health and Human Sciences Cooperative Extension has numerous programs that are described on their state website. Several programs can be made available to residents of Bartholomew County. They have been listed below. If you see other programs listed at the state level or would like to request a special program to meet your organization's needs, please add to the "Other" section below. Fuller descriptions of the programs can be found at http://www.purdue.edu/hhs/extension/. (As you hover over the general areas listings will appear. On the far right hand side, you can click to get a full description of all the programs.) Check all programs that might be of interest. Questions regarding the programs can be sent to Health & Human Sciences Program Assistant, Harriet Armstrong, at armstrh@purdue.edu.

7. Thank you for taking time to complete this survey. Your interest and feedback is greatly appreciated. Harriet Armstrong, Health & Human Sciences Program Assistant, will be contacting you at a later date. (Additional comments can be made below.)

T