Survey for HIV/STD and Pregnancy Prevention Facilitators and Trainings

Exit this survey

 

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1. Specify evidence-based curriculum able to facilitate*
Curriculum include Making Proud Choices, Parents Matter, Safer Choices, Reducing the Risk, etc. (Must have qualified training)
*If there is more than one staff person trained at your agency, indicate the number available to conduct trainings beside each curriculum and provide only the contact information of the main facilitator below. If no one is trained, state none.

Specify evidence-based curriculum able to facilitate* Curriculum include Making Proud Choices, Parents Matter, Safer Choices, Reducing the Risk, etc. (Must have qualified training) *If there is more than one staff person trained at your agency, indicate the number available to conduct trainings beside each curriculum and provide only the contact information of the main facilitator below. If no one is trained, state none.

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2. Specify evidence-based curriculum that you would like to receive trainings for. If you do not want to receive additional trainings, indicate none.

Specify evidence-based curriculum that you would like to receive trainings for. If you do not want to receive additional trainings, indicate none.

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3. Would you feel comfortable working with a Health Teacher and serving as a resource for your local school?

Would you feel comfortable working with a Health Teacher and serving as a resource for your local school?   Yes

No

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4. Are you familiar with the GCS 115C-81, Basic Education Program, specific requirements for Education in North Carolina?

Are you familiar with the GCS 115C-81, Basic Education Program, specific requirements for Education in North Carolina?   Yes

No

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5. Do you know the specific requirements of the Healthy Youth Act 2009?

Do you know the specific requirements of the Healthy Youth Act 2009?   Yes

No

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6. Are you familiar with or are you a member of your School Health Advisory Committee (SHAC)?

Are you familiar with or are you a member of your School Health Advisory Committee (SHAC)?   Yes

No

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7. Are you responsible for disseminating school health information to parents/legal guardians in community based settings?

Are you responsible for disseminating school health information to parents/legal guardians in community based settings?   Yes

No

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8. Rate your response on a scale of 1 (low) to 5 (high):
What is your experience in working with Public Schools and alternative classrooms in the delivery of school health education instruction?

Rate your response on a scale of 1 (low) to 5 (high): What is your experience in working with Public Schools and alternative classrooms in the delivery of school health education instruction?   1

2

3

4

5

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9. Provide Contact Information:
Agency
Name and Position
Address
Phone
Email

Provide Contact Information: Agency Name and Position Address Phone Email