Song Brown Nursing Student/Graduate Survey, Fall 2009
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1. Song Brown Grant Application, Cabrillo Nursing Student/Graduate Survey

 
We are collecting this data in order to submit a grant application to the Song Brown Health Care Workforce Training Act Registered Nurse Education Program. The data collected through this survey will not be kept for any other reason and will not be part of your student records here at Cabrillo.

We need the results by October 21st, 2009 so please respond ASAP. Thank you everyone!

1. Last name

2. First name

3. Gender

4. Academic Year of graduation

5. Full Address (street, apt.#, city/state, zip)

6. Phone number, including area code:

7. Ethnicity

8. What language is spoken at home?

9. Do you speak a second language well enough to discuss patient care? If so, please note which language:

10. Name of current practice site:


11. Address of current practice site.

12. Zip code of current practice site (this one is important!)