Health Disparities in Rural Settings CE Evaluation Tool

1. Instructions for Filling out this Survey

Thank you for filling out the Health Disparities in Rural Settings CE Evaluation Tool.

Once you complete this CE Evaluation please e-mail midwifery@su.edu and let us know, so we can send you a certificate.

Question Title

* 1. Please fill out the following information so that we can mail your CE certificate to you. You will not be contacted for any other reason than this and all of your information is kept private. It will not be shared.

Name:

Session(s) completed:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number: