Educational Exchange Host Experience Evaluation

Please complete this form to help us evaluate the NOSORH Educational Exchange program. Please complete the evaluation in full and submit when completed.

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1. Resource Contact Information

Name of the traveler who visited your state:

Name of person(s) who provided the educational exchange:

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2. Of what benefit was the educational exchange to your State Office of Rural Health?

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3. How do you plan to utilize the information gathered from your educational experience? (check all that apply)

Share with staff

Share with rural communities

Share with partners (e.g., state primary care association)

Track the issue or learn more about it

Initiate an activity such as investigating or starting a new program or changing an existing program

Please describe:

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4. What was your overall response to this educational exchange?

Unsatisfactory

Satisfactory

Excellent

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5. Please provide any suggestions you have for improving the Educational Exchange program:

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6. Did you experience any challenges/barriers to hosting the traveler?

Yes

If yes, please describe your challenges/barriers.

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7. Will you continue to host other SORHs in the future?

Yes

If not, please indicate your reasoning.

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* 1. Resource Contact Information

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* 2. Of what benefit was the educational exchange to your State Office of Rural Health?

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* 3. How do you plan to utilize the information gathered from your educational experience? (check all that apply)

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* 4. What was your overall response to this educational exchange?

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* 5. Please provide any suggestions you have for improving the Educational Exchange program:

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* 6. Did you experience any challenges/barriers to hosting the traveler?

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* 7. Will you continue to host other SORHs in the future?

1. Resource Contact Information

2. Of what benefit was the educational exchange to your State Office of Rural Health?

3. How do you plan to utilize the information gathered from your educational experience? (check all that apply)

4. What was your overall response to this educational exchange?

5. Please provide any suggestions you have for improving the Educational Exchange program:

6. Did you experience any challenges/barriers to hosting the traveler?

7. Will you continue to host other SORHs in the future?