1. About Continuing Education for this Event

The GVAHEC is pleased to provide continuing education for this event. The following questions are REQUIRED in order to receive continuing education. You must complete the evaluation of learning objectives for each session that you attended and for which you are requesting credit.
Please be sure to provide a VALID email address. Continuing education certificates will be emailed to you as a PDF. Please allow 10 business days for processing.

If you do not receive your certificate within 10 business days of submitting you request please email:
Renee A. Ruby at rruby@empowermentsystems.org or call 480-288-8260x100.
Anyone requesting continuing education certificates or certificates of completion must do so within 30 days of the event.

* 1. Please provide the following information as you would like it to appear on your certificate.

* 2. YOUR CERTIFICATE WILL BE EMAILED IN 10 Business DAYS>>>>Please provide a valid email address where your certificate will be sent and a phone number in case we have questions.

* 3. Did you attend the entire session on April 19th and 20th 2017

* 4. Are you requesting continuing education for: 

* 5. If applicable, please include your license or registration number at is pertains to the certificates you requested above. If you selected "Certificate of Participation" no license number is required (please enter: 0000).

* 6. CE/CME Participant Satisfaction Survey
Please circle the number that best describes your agreement with the following statements.

1 Strongly Disagree
2 Disagree
3 No Opinion
4 Agree
5 Strongly Agree

  1 2 3 4 5
The educational objectives were well met.
The speaker(s) demonstrated a thorough knowledge of the subject matter.
The presentation content related appropriately to the objectives.
I would recommend this program to my colleagues.
The training program /conference reflected current issues.
The speaker (s) applied the material covered to the practice setting.
I attended this program because the content was relevant to my practice.
My expectations for this program were well met.
The speaker(s) demonstrated product bias during the presentation.
Please rate the overall quality of the speakers.

* 7. Of all the factors that influence your satisfaction in your current practice setting, how would you rate the provision of Continuing Education Opportunities? (Select One)


* 8. Please select your primary occupation.

* 9. What is your current employment location or setting?

* 10. What is your Race?

* 11. What is your Ethnicity?

* 12. Age Range:

* 13. Gender

* 14. Would you like to receive emails regarding other continuing education events and opportunities from the Greater Valley Area Health Education Center? (we will use the email you provided unless you specify otherwise below)

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