Online Needs Assessment Form

Please take a minute to complete this survey. If you have any questions or comments regarding the survey, please contact Dani Kennedy, Assistant Director, Health Care Professional Development Program, at 610-519-4930 or by email. Thank you for your time!

If other, please specify:

Job/Title/Area:

Are you willing to travel to attend programs?:

Yes No

Which day(s) of the week would you most likely attend a continuing education activity?:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

If there was one continuing education offering you would like to see provided on-line, what would that topic be?:

Are you located in an urban or rural setting?:

Urban Rural

Are you interested in distance learning programs?:

Yes No

How did you hear about us?:

Advertisement/Mailer Alumni Colleague Website Other

May we contact you via email for further inquiries and program updates?:

Yes No

If yes, please provide email address:

Comments:

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Online Needs Assessment Form