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* 1. Name of Institution:

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* 2. Name of Faculty

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* 3. Which of the following National HIV Curriculum (NHC) modules have you reviewed? Please circle all responses that apply

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* 4. How well does the NHC align with the overall curriculum offered by your department? Please circle one response only.

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* 5. Please explain the rationale for your response to Question 2.

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* 6. How many students from your program are currently taking NHC modules?

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* 7. How many students from your program do you anticipate will complete the NHC modules during this academic (2018) year?

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* 8. How easy has it been to persuade students to take the NHC modules? Please circle one response only.

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* 9. Please explain the rationale for your response to Question 6.

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* 10. Which of the following Modules has been the most challenging for students? Please circle one response only.

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* 11. Please explain the rationale for your response to Question 8.

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* 12. Which of the following Modules has been the easiest for students? Please circle one response only.

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* 13. Please explain the rationale for your response to Question 10.

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* 14. What assistance have you offered to students to facilitate their performance on the NHC modules?

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* 15. Is there assistance that your students need relative to their performance on the NHC that you are currently unable to provide? Please circle one response only.

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* 16. If yes, please describe below.

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* 17. Is there assistance that you, as a faculty member, need to facilitate the integration of the NHC into your overall program curriculum? Please circle one response only.

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* 18. If yes, please describe below.

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* 19. Please note below any additional comments you have relative to your institution’s participation in HNIP.

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