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* 1. Institution

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* 2. Name and Position

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* 3. Check all that apply

I have discussed/used COEUR with the following people/groups:

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* 4. If you checked "Other administrative group" and/or "One or more administrators" in previous question, please specify:

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* 5. Check all that apply

The purpose of the discussions and/or using COEUR was:

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* 6. How did you disseminate the COEUR document information? Check all that apply.

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* 7. In the next 12 months I hope to use COEUR to….

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* 8. Any suggestions, based on your experiences thus far, for others using COEUR? For example, did small group discussions with preselected prompts work at a department meeting? Did you receive any comments about COEUR that you did not expect?

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* 9. Can we contact you to discuss your experiences in using COEUR? If so, please provide your e-mail address below.

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