CHES Assessment & Evaluation: Health Equity and Prevention Primer

1. Demographic Information

Question Title

* 1. Please provide some demographic information:

Name:

Organization:

City/Town:

State:

Email Address:

Phone Number:

Question Title

* 2. What type of community or communities does your organization serve?

Urban

Rural

Suburban

Tribal

Question Title

* 3. What is your job title?

Question Title

* 4. What type of organization do you work for?

Public Health Department

School

Non-profit

Other

If "other" please specify:

Question Title

* 5. CHES ID number:

Note: CHES-certified users can receive five hours of credit for completing all seven modules. In order to receive credit, please email prevent@preventioninstitute.org to inform us that you have completed this evaluation. You will receive a certificate of course completion when your request is submitted to NCHEC in a quarterly report.