How would you like your name to appear on your certificate?

Profession

How many credit hours did you complete?

Credit Hours (maximum: 22.5)

Agreement

By completing this form, you attest that you have attended the number of hours you have indicated above.

I agree

Please rate your satisfaction with the content and quality of the program:

Was the educational content scientifically sound?

Yes

No

If no, please explain...

Did you perceive any commercial bias or influence in the educational content?

Yes

No

If yes, what...

Did this program improve your competence or performance?

Yes

No

If yes, how...

If no, please explain...

What did you learn that will help you in your practice?

Were the following objectives met?

Objective 1: Describe how community connections impact AYA health and development

Yes

No

Not sure

Were the following objectives met?

Objective 2: Identify and utilize these connections that reside outside the health care system

Yes

No

Not sure

Were the following objectives met?

Objective 3: Apply these connections to improve health outcomes for the AYA population

Yes

No

Not sure

The program was up-to-date and relevant to my professional practiceÂ

Additional comments

Was the location suitable?

Yes

No

The facilities were conducive to learning

Yes

No

Not sure

What questions are you having in your practice that you would like to see addressed in an educational activity?

Questions, concerns and accommodations were addressed efficiently and in a timely manner

Only Florida Licensees need to answer this question.

Notice for Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g., CDCA.XXXXXX, LCDCII.XXXXXX, LCDCIII.XXXXXX, LICDC.XXXXXX). Please be sure you enter this number accurately, or CE Broker will not record your hours.

Additional comments