Question Title

* 1. Date of Activity:

Date
Unique Identifier
To protect your anonymity and to allow us to match your responses to data we will collect after the Faculty workshop, we ask you to compose a personal identification code according to the following instructions:
1) First letter of your mother's first name
2) First letter of your mother's maiden last name
3) the last three digits of your Social Security Number
(for example, if your mother's maiden name was Alice Smith and your Social Security Number was 000-34-6789, your code would be AS789)

Question Title

* 2. Your code:

Question Title

* 3. Affiliation(s) [check all that apply]

 
Academic affairs
Graduate School
Health Professions
Medicine
Nursing
Pharmacy
Public Health
Regional Programs

Question Title

* 4. Degree(s) [check all that apply]

 
APRN
DNP
EdD
MD
PhD
PharmD
RN

Question Title

* 5. Rank (check one)

 
Instructor
Assistant Professor
Associate Professor
Full Professor

Question Title

* 6. How well did this activity meet its objective:
         1 = poorly   5 = exceptionally

  1 2 3 4 5
Describe the impact of health behaviors on personal and professional wellness and vitality
Identify resources available to assist with reaching wellness goals
Develop and implement a lifestyle change plan

Question Title

* 7. Please rate the degree of impact from today's activity:
1 = strongly disagree  5 = strongly agree

  1 2 3 4 5 N/A
I will implement changes based on what I've learned today
In general, I learned something important from this activity
This activity was an effective use of my time
Please identify the following aspects of today's activity:

Question Title

* 8. The least effective and describe how it could be improved:

Question Title

* 9. The most effective and describe how it could be improved:

Question Title

* 10. What is your top takeaway message from this workshop:

Question Title

* 11. Other topics on wellness and vitality that you would like to see:

T