CHES Assessment & Evaluation: Health Equity and Prevention Primer

Exit this survey

 

1. Please provide some demographic information:

Please provide some demographic information:   Name:
Organization:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
Email Address:
Phone Number:

2. What type of community or communities does your ogranization serve?

What type of community or communities does your ogranization serve?   Urban Rural Suburban Tribal

3. What is your job title?

What is your job title?

4. What type of organization do you work for?

What type of organization do you work for?   Public Health Department School Non-profit Other

If "other" please specify:

5. CHES ID number:

Note: CHES-certified users can receive 5 hours of credit for completing all seven modules. In order to receive credit, please email Virginia Lee at virginia@preventioninstitute.org to inform her that you have completed this evaluation.

CHES ID number: Note: CHES-certified users can receive 5 hours of credit for completing all seven modules. In order to receive credit, please email Virginia Lee at virginia@preventioninstitute.org to inform her that you have completed this evaluation.