Fast 15 Survey - Chapter Work Plan

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* 1. Please complete the following:

Name

Chapter Name

Chapter #

State:

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* 2. What is your chapter role?

Chapter President

Chapter President-Elect

Chapter Secretary

Chapter Treasurer

Chapter Health Policy Representative

Other (please specify)

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* 3. How would you rate this learning module?

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
This Fast 15 met the objectives.	This Fast 15 met the objectives. Strongly Agree	This Fast 15 met the objectives. Agree	This Fast 15 met the objectives. Neutral	This Fast 15 met the objectives. Disagree	This Fast 15 met the objectives. Strongly Disagree
I feel more confident on how to create a chapter work plan.	I feel more confident on how to create a chapter work plan. Strongly Agree	I feel more confident on how to create a chapter work plan. Agree	I feel more confident on how to create a chapter work plan. Neutral	I feel more confident on how to create a chapter work plan. Disagree	I feel more confident on how to create a chapter work plan. Strongly Disagree
A chapter work plan will be created for my chapter.	A chapter work plan will be created for my chapter. Strongly Agree	A chapter work plan will be created for my chapter. Agree	A chapter work plan will be created for my chapter. Neutral	A chapter work plan will be created for my chapter. Disagree	A chapter work plan will be created for my chapter. Strongly Disagree

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* 4. Do you have any questions about the Chapter Work Plan that were not answered in the module?

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* 5. Please share any other questions or comments you have about Chapter Work Plans: