Who's Who of Three Rivers AHEC: Where are you now? Survey

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1. Please provide your name and email address.

Please provide your name and email address.

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2. Please provide your place of employment to include city and state.

Please provide your place of employment to include city and state.

3. Did you participate in one of our Health Career Programs? Click all that apply.

Did you participate in one of our Health Career Programs? Click all that apply. Anchor: Clinical Training in West Central Georgia

Chart the Course Health Careers Academy

High School Mentoring Program

Summer Camp

Other (please specify)

4. Did you complete a clinical rotation coordinated through our AHEC?

Did you complete a clinical rotation coordinated through our AHEC? Yes

No

Not Sure

Specialty and City

5. Which social media networking sites do you use? (check all that apply)

Which social media networking sites do you use? (check all that apply) Blogs Facebook MySpace	Linked In Twitter
Other (please specify)

6. Thank you for taking the time to complete our survey today.

It is the policy of Three Rivers Area Health Education Center (AHEC) to ensure that the information obtained through our various programs and activities on employees, Board of Directors, volunteers, preceptors, participants, youth, and other individuals or organizations is treated as confidential and stored in secured electronic and/or on-site storage systems. This information is provided by individuals to Three Rivers AHEC for the purpose of communication between them and Three Rivers AHEC.

This information will not be released to outside parties without the knowledge or consent of the individuals involved.

For questions regarding Three Rivers AHEC's privacy policy or this survey, please contact:
Kathy English, Center Director
(706) 507-0894 Ext. 1
kenglish@threeriversahec.org

Please use the space below to identify any other comments you might have about Three Rivers AHEC program offerings.

Thank you for taking the time to complete our survey today. It is the policy of Three Rivers Area Health Education Center (AHEC) to ensure that the information obtained through our various programs and activities on employees, Board of Directors, volunteers, preceptors, participants, youth, and other individuals or organizations is treated as confidential and stored in secured electronic and/or on-site storage systems. This information is provided by individuals to Three Rivers AHEC for the purpose of communication between them and Three Rivers AHEC. This information will not be released to outside parties without the knowledge or consent of the individuals involved. For questions regarding Three Rivers AHEC's privacy policy or this survey, please contact: Kathy English, Center Director (706) 507-0894 Ext. 1 kenglish@threeriversahec.org Please use the space below to identify any other comments you might have about Three Rivers AHEC program offerings.

Who's Who of Three Rivers AHEC: Where are you now?

*1. Please provide your name and email address.

*2. Please provide your place of employment to include city and state.

3. Did you participate in one of our Health Career Programs? Click all that apply.

4. Did you complete a clinical rotation coordinated through our AHEC?

5. Which social media networking sites do you use? (check all that apply)

*
1. Please provide your name and email address.

*
2. Please provide your place of employment to include city and state.