To participate in the Community Health Worker’s Stroke Training Course, please provide the following information:
  1. Contact and Demographic Information: Complete the required fields on the first page.
  2. Pre-Test: Fill out the pre-test on the second page.
  3. Subjective Questionnaire: Complete the questionnaire on the last page.
All steps are required to obtain your Continuing Education credits.

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* 1. Contact Information & Associated

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* 2. Name of County you are associated with in Florida:

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* 3. Affiliated institutions:

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* 4. Age Range:

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* 5. Gender:

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* 6. Have you taken a stroke training program before?

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* 7. Would you like to join a local Stroke Coalition near you?

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* 8. Which race/ethnicity best describes you? (Please choose only one.)

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