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Pilot Participants for Small Steps to Eye Care Action Plan: A Conversation Guide

Pilot Participants for the Small Steps to Eye Care Action Plan: A Conversation Guide

Thank you for piloting the Small Steps to Eye Care Action Plan: A Conversation Guide. For this step, we are collecting demographic information on Pilot Participants. After you complete the questions, you will receive a draft copy of the Action Plan and another SurveyMonkey questionnaire to tell us your thoughts about the Action Plan after you use the Action Plan with one or more families.
1.Please provide your contact information(Required.)
2.Your title
3.Your credentials
4.Please describe where you work (check all that apply)
5.What are the demographics of your students/clients? Check all that apply
6.If you serve tribal, immigrant, refugee or migrant populations, please list names of tribes and/or countries of origin of the children in your school/program.
7.Please tell us about yourself. Check all that apply
8.For how long have you been working with families whose child received a referral from a vision screening?
Current Progress,
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