The City of Nashua Division of Public Health and Community Services, Greater Nashua Public Health Network would like to congratulate and thank your organization for hosting an educational opportunity (event, training, conference, etc.) in the Greater Nashua Region! Upon completion of your event, we request that you complete this survey, the 2018-2021 Greater Nashua CHIP Educational Opportunity Tracking Form, to assist us in tracking and evaluating health improvement activities within the region.

If your event already required you to complete a tracking form, please feel free to skip this survey and send them to 2018.2021CHIP@gmail.com.

If you have any questions about completing this survey, or in regards to the 2018-2021 Greater Nashua CHIP, please contact Nicole Viau at viaun@nashuanh.gov or 603.589.4508.

Question Title

* 1. Enter the following information about your organization's educational opportunity.

Question Title

* 2. Enter the point of contact information for your organization's educational opportunity.

Question Title

* 3. Enter the total time spent on this educational opportunity.
Please include time for all staff involved with planning and implementation. 

Question Title

* 4. Was this educational opportunity part of a series?

Question Title

* 5. List the number of attendees by age. 
If not tracked, please do not estimate.

Question Title

* 6. List the number of attendees by race.
If not tracked, please do not estimate.

Question Title

* 7. List the number of attendees by ethnicity.
If not tracked, please do not estimate.

Question Title

* 8. List the number of attendees by town.
If not tracked, please do not estimate.

Question Title

* 9. Explain the intended or target audience that this educational opportunity was designed for.

Question Title

* 10. Describe the audience that attended this educational opportunity.

Question Title

* 11. List the topic(s) covered at this educational opportunity.

Question Title

* 12. If any, describe future collaboration opportunities that were developed from this educational opportunity.

Thank you for completing this tracking form! 

If your educational opportunity has any evaluation summary reports, please email them to 2018.2021chip@gmail.com.
0 of 12 answered
 

T