Caregiver Educational Program Needs Questionnaire (CEPNQ)

Demographic Information

Welcome to the Caregiver Educational Program Needs Questionnaire (CEPNQ). The purpose of this CEPNQ is to help us learn about the educational needs of caregivers of individuals with Acquired Brain Injury (ABI).

We want your help in identifying the most important topics to include in an educational program/workshop for family caregivers of adults, children, or youth with ABI.

Question Title

* 1. Age of Person with ABI:

10 years of age or younger

11 - 19 years of age

20 - 39 years of age

40 - 59 years of age

60 years of age or older

Question Title

* 2. Number of years since ABI injury:

2 years and under

3 - 5 years

6 - 10 years

over 10 years

Question Title

* 3. Town/City you live in:

Question Title

* 4. Age of Questionnaire Respondent/ABI Caregiver:

15 to 24 years of age

25 to 49 years of age

50 to 64 years of age

65 years of age or older