Please complete each question honestly before the online training. Your answers will remain confidential and not be shared with anyone, including your supervisor. Your responses will help us to improve our programs.

* 1. First Name

* 2. Last Name

* 3. What are the last 4 digits of your work phone number?

* 4. At what division do you work?

* 5. How long have you worked as an Eligibility Technician (ET)?

* 6. The CHDP program is only for infants and toddlers?

* 7. What is included in a CHDP exam?

* 8. What is an example of an anticipatory guidance topic?

* 9. CHDP Gateway is:

* 10. CHDP is responsible for:

* 11. What is the benefit of regular well-child check-ups?

* 12. Eligibility staff are responsible for informing families about CHDP.

* 13. Eligibility staff are responsible completing and submitting the PM357 to the CHDP Program.

Thank You!