Colby PTA Program Observation Hour Survey

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* 1. Type Your First Name and Last Initial (Required to receive points)

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* 2. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. Did you watch the video?

Yes

No

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* 4. Select which settings you are MOST interested in after watching the video:

Research

Rehab

Neuro Rehab

Pediatric

Outpatient

Oncology

Geriatric

Women's Health

Sports Rehab

Education

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* 5. Provide a brief explanation on what clinical aspect excites you the MOST. Please state more than just helping people.