Interest in future PREVENT Institutes Survey

Thank you for your interest in PREVENT. Our training approach involves an initial 2-3 day on-site training, followed by a 6-month coaching period, finishing with a second 2-3 day on-site training. Please fill out this survey so that we can design future PREVENT trainings to match your training needs.

1. If PREVENT offered training in the following areas, in which, if any, might you be interested (please check all that apply)?

If PREVENT offered training in the following areas, in which, if any, might you be interested (please check all that apply)? Child maltreatment

Sexual violence

Intimate partner violence (IPV)

Suicide/attempted suicide

Gun violence

Youth violence

Workplace violence

Home environment (children, adults, elderly)

Traffic safety

Workplace safety

International settings

Other (please specify)

2. Which of these skill areas are you interested in enhancing? Check all that apply.

Which of these skill areas are you interested in enhancing? Check all that apply. Obtaining, accessing and interpreting public health data on injury and/or violence

Designing effective injury/violence prevention policies and/or programs at a population level (e.g., for a state or community)

Organizing effective injury/violence prevention interventions in a community

Managing an effective injury/violence prevention program

Finding and using evidence about prior interventions to guide intervention development

Evaluating intervention program or policy

Communicating and disseminating injury/violence prevention information to communities, other professionals, policy makers and leaders.

Other (please specify)

3. Would you be able to travel to Chapel Hill, NC for both 3-day on-site sessions of the PREVENT training Institutes (airport is Raleigh-Durham)?

Would you be able to travel to Chapel Hill, NC for both 3-day on-site sessions of the PREVENT training Institutes (airport is Raleigh-Durham)? Yes

4. If yes, would you or your organization be able to cover the cost of your travel to Chapel Hill, NC?

If yes, would you or your organization be able to cover the cost of your travel to Chapel Hill, NC? Yes

5. If you are unable to travel to Chapel Hill, NC, would you be able to travel a shorter distance, such as:

If you are unable to travel to Chapel Hill, NC, would you be able to travel a shorter distance, such as: 0-50 miles from your home

51-100 miles from your home

101-150 miles from your home

151-200 miles from your home

6. Assuming you had sufficient lead time to plan with your organization, how much of the total tuition (valued at more than $2000 for curriculum, faculty, meals and lodging) do you anticipate that you or your organization would be able to pay to attend this training?

Assuming you had sufficient lead time to plan with your organization, how much of the total tuition (valued at more than $2000 for curriculum, faculty, meals and lodging) do you anticipate that you or your organization would be able to pay to attend this training?

7. Would you need help finding a scholarship to cover all or part of the tuition?

Would you need help finding a scholarship to cover all or part of the tuition? Yes

Not sure

8. Would the availability of continuing education credits be of value to you?

Would the availability of continuing education credits be of value to you? Yes

Not sure

9. Would the availability of a certificate in injury and violence prevention from the University of North Carolina for the PREVENT Institute be of value to you?

Would the availability of a certificate in injury and violence prevention from the University of North Carolina for the PREVENT Institute be of value to you? Yes

Not sure

10. What degrees/certifications do you currently have? Check all that apply.

What degrees/certifications do you currently have? Check all that apply. MSW or equivalent

MSN or equivalent

MPH or equivalent (specify discipline below)

MD, DDS, DVM or equivalent

PhD or equivalent (specify discipline below)

EMT or equivalent

BSN or equivalent

Other health care background (e.g., OT, PT, RT)

Other (please specify)

11. Would you be interested in receiving more information on future PREVENT Institutes?

Would you be interested in receiving more information on future PREVENT Institutes? Yes

No, thank you

12. If yes, please provide your name and email address below.

If yes, please provide your name and email address below.

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