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This will confirm your participation in the event for continuing education credit and also provide us valuable insights about sustaining and improving resources to support implementation of developmental screening efforts. Your name will not be entered into the evaluation report with your survey responses. However, everyone who completes a survey will be entered into a drawing during each session to receive a prize.

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* 1. Name:

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* 2. Phone Number:

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* 3. E-mail:

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* 4. County You Are Located:

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* 5. Registry Number:

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* 6. Which Webinar did you just attend?

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* 7. Did you listen to the developmental screening webinar on the date indicated in the previous question?

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