Thank you for completing the Pontotoc County Drug Free Coalition (PCDFC) Parent360 RX/OTC Module. Please take a moment to fill out this assessment to help us improve our programs and strategies. This assessment is confidential and your name will not be tied to any results or shared with any other entities. However, you will be asked to provide your name and email at the end of the assessment if you would like to receive a certificate of completion for this module or if you wish to be added to PCDFC's contact lists. Alternately, you can email holrwit@ecok.edu with a copy of the completion page to receive a certificate if you do not wish to leave your name below or to be added to PCDFC contact lists.

Question Title

* 1. What is your age?

Question Title

* 2. What is your race or ethnicity?

Question Title

* 3. What is your occupation?

Question Title

* 4. What are the ages of your children?  Please select all that apply.

Question Title

* 5. During the past 30 days, have you talked to your child about the dangers of misuse of prescription drugs?

Question Title

* 6. How wrong do you think it would be for your child to...

  Very Wrong Wrong A little bit wrong Not at all wrong
Take prescription drugs not prescribed to them
Take more prescription drugs at a time than prescribed
Take prescription drugs more often than prescribed
Take prescription drugs with the intent to get 'high'
Take prescription drugs at a later date than prescribed

Question Title

* 7. How strongly do you agree/disagree with the following statement: "I believe the misuse of prescription medications among youth is a problem in Pontotoc County."

Question Title

* 8. If the police became aware that Pontotoc County teens were misusing prescription drugs, what action would you support regarding the teens? Please select all that apply.

Question Title

* 9. Prior to today, have you actively monitored or taken stock of any prescription medications in your home?

Question Title

* 10. Prior to today, have you secured or locked up prescription medications in your home?

Question Title

* 11. Prior to today, were you aware of Pontotoc County's prescription drug drop box locations?

Question Title

* 12. Prior to today, have you used Pontotoc County's prescription drug drop box locations?

Question Title

* 13. Prior to today's module, please rate your level of knowledge about prescription drug abuse issues.

Question Title

* 14. After completing today's module, please rate your level of knowledge about prescription drug abuse issues.

Question Title

* 15. After completing the module, what action do you plan on taking? (Please select all that apply).

Question Title

* 16. How would you rate the Rx/OTC module?

Question Title

* 17. How did you hear about this module?

Question Title

* 18. Do you have any comments or feedback about the video?

Question Title

* 19. What other information do parents need to know about prescription drug abuse?

Question Title

* 20. Do you have any other comments or suggestions about today's module?

Question Title

* 21. Please provide your name & email address if you would like to receive a certification of completion for the Rx/OTC Module. Please type your name as you would like it to appear on the certificate. (Alternately, you can email holrwit@ecok.edu with a copy of the completion page, which will appear after you click submit, to receive a certificate if you do not wish to leave your name below).

Question Title

* 22. Please provide your name and contact information if you would like to be added to the Pontotoc County Drug Free Coalition email and/or mailing list to receive information about coalition meetings and activities. (Alternately, you can email holrwit@ecok.edu to be added to PCDFC contact lists if you do not wish to leave your name below).

T