Post Activity Survey

Please answer the questions below.

Question Title

* 1. Assigned ONA Application #

Question Title

* 2. Title of activity.

Question Title

* 3. Name of organization/applicant.

Question Title

* 4. Date this activity was held.

Question Title

* 5. What was the city and state that this program was offered?

Question Title

* 6. What was your target audience (RN, LPN, Interprofessional)?

Question Title

* 7. Total number of participants.

Question Title

* 8. Enter total number of contact hours offered upon completion.

Question Title

* 9. Did this activity receive commercial support?

Yes

No

Question Title

* 10. Amount of commercial support.

Question Title

* 11. If there was an evaluation, what changes will you make based on evaluation by learners of the activity? (Even if your program will only be presented one time, please answer this question as if it were being repeated).

Question Title

* 12. Was your outcome(s) met?

Yes

No

Question Title

* 13. Upload a copy of the certificate your learners received.

Please pdf your certificate for the file upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.