Participant Information for Introduction to Quality Improvement for Family Planning

For the purposes of the National Training Centers' evaluation, we need a little information from you before you start this e-learning module.

The link to the e-learning module is provided at the end of the survey.

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* 1. Please provide the zip code for your primary workplace (e.g., where you work):

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* 2. Which of the following best describes your workplace setting? (select one)

Health department (e.g., state, county, local)

Hospital-based

Planned Parenthood

Free-standing Family Planning Organization

Community health center/Federally Qualified Health Center

Tribal health center

University-based

School-based

Faith-based

Correctional facility-based

Other private, non-profit

Federal government

Other (please specify):

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* 3. How many years have you worked in the field of family planning? (select one)

Less than 2 years

2 to 5 years

6 to 10 years

11 to 20 years

Greater than 20 years

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* 4. What best describes your primary role at your workplace? (select one)

Health Educator/Counselor/Health Care Associate/Medical Assistant

Community Outreach Staff

Manager/Administrator/Center Coordinator

Clinical Provider

Nurse

Front Desk/Reception

Billing/Finance Assistant

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* 5. What is your organization’s Title X affiliation (select one)

Grantee

Sub-recipient/Delegate

Service site

Do not receive Title X funding

OFP/Title X federal staff

NTC staff

Not sure/Don’t know

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* 6. Where did you hear about the training? (select all that apply)

NTC newsletter via email

Received OPA’s weekly email directly

Received OPA's weekly email forwarded from grantee/sub-recipient

NTC website

Colleague

Regional Program Consultants

Twitter

Other (please specify)

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* 7. Are you Hispanic or Latino? (select one, optional)

Hispanic or Latino

Non-Hispanic or Latino

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* 8. What is your racial background? (select one, optional)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

More than one race

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* 9. What is your gender? (select one, optional)

Male

Female