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CHES Assessment & Evaluation: Health Equity and Prevention Primer

1. Demographic Information

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* 1. Please provide some demographic information:

Name:

Organization:

City/Town:

State:

Email Address:

Phone Number:

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

Urban

Rural

Suburban

Tribal

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* 3. What is your job title?

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* 4. What type of organization do you work for?

Public Health Department

School

Non-profit

Other

If "other" please specify:

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* 5. CHES ID number:

Note: CHES-certified users can receive five hours of credit for completing all seven modules. In order to receive credit, please email prevent@preventioninstitute.org to inform us that you have completed this evaluation. You will receive a certificate of course completion when your request is submitted to NCHEC in a quarterly report.