Exit this survey Teach-back program feedback How did you hear about our teach-back program materials? Question Title * 1. How did you hear about our teach-back program materials? Minnesota Health Literacy Partnership website RARE program Many Faces of Community Health conference Colleague NIFL listserve Stratis Health Culture Care Connections Other (please specify) How do you plan to use or how did you use the program materials? Question Title * 2. How do you plan to use or how did you use the program materials? How would you rate the overall usefulness of this program? Question Title * 3. How would you rate the overall usefulness of this program? Very useful Somewhat useful Not at all useful What resource/tool was most useful to you? Question Title * 4. What resource/tool was most useful to you? Program guide PowerPoint presentation Video example Activity ideas Measurement tips Other (please specify) How likely are you to recommend this program to someone else? Question Title * 5. How likely are you to recommend this program to someone else? Very likely Somewhat likely I would not recommend this program Do you have any suggestions for how we could improve this program? Question Title * 6. Do you have any suggestions for how we could improve this program? Please provide the following demographic information. Question Title * 7. Please provide the following demographic information. Name: Company: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Email Address: Phone Number: Would you like to be contacted about your answers by a representative from the Minnesota Health Literacy Partnership? Question Title * 8. Would you like to be contacted about your answers by a representative from the Minnesota Health Literacy Partnership? Yes No May we use the information you provided in further promotion of our program? (For example, quote on website, acknowledge use of program, share with other users of program materials.) Question Title * 9. May we use the information you provided in further promotion of our program? (For example, quote on website, acknowledge use of program, share with other users of program materials.) Yes, I give permission for the information I provided in this survey to be used in promotional and ongoing information sharing about this program. No, I DO NOT give permission for the information I provided to be used in any way. Other (please specify) Thank you for taking the time to complete our suvey Done