Thank you for playing the CCHN/CHAMPS Rural Social Determinants of Health Game! We appreciate you taking the time to complete this brief evaluation of the game toolkit, which will allow us to continue to improve this resource for Community Health Centers and other rural health safety net organizations.

What state(s) do you work in? Please select all that apply:

Question Title

* 1. What state(s) do you work in? Please select all that apply:

What is the name of the organization where you work?

Question Title

* 2. What is the name of the organization where you work?

What is your job title or professional role? 

Question Title

* 3. What is your job title or professional role? 

On what date did you play the Rural Social Determinants of Health Game? (If you don't remember, please provide your best guess.)

Question Title

* 4. On what date did you play the Rural Social Determinants of Health Game? (If you don't remember, please provide your best guess.)

Date / Time
Did you participate in the game as:

Question Title

* 5. Did you participate in the game as:

Please rate your overall satisfaction with the Rural Social Determinants of Health Game Toolkit on a scale of 1 to 10 (10 being highly satisfied, 1 being highly dissatisfied).

Question Title

* 6. Please rate your overall satisfaction with the Rural Social Determinants of Health Game Toolkit on a scale of 1 to 10 (10 being highly satisfied, 1 being highly dissatisfied).

This game gave me practical knowledge and skills that I will use while working:

Question Title

* 7. This game gave me practical knowledge and skills that I will use while working:

Please describe how this game toolkit could be improved:

Question Title

* 8. Please describe how this game toolkit could be improved:

Please describe the best aspects of this game toolkit:

Question Title

* 9. Please describe the best aspects of this game toolkit:

Please provide any other comments or feedback:

Question Title

* 10. Please provide any other comments or feedback:

Thank you for completing this evaluation - we truly appreciate your input!

T