Online Survey | Built with Qualtrics Experience Management™

The University of North Carolina at Chapel Hill
Program for Ethnicity, Culture, and Health Outcomes (ECHO)
Minority Health Project
Your guide to minority health-related activities at UNC and elsewhere

Men’s Health Disparities: Implications for Research and Intervention

14th Annual Summer Public Health Research Institute
and Videoconference on Minority Health

Participant Evaluation Form

Please tell us about your Videoconference experience.

**Please tell us about your** Videoconference **experience.**
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
1. The Videoconference increased my understanding of this subject and its relation to public health.	1. The Videoconference increased my understanding of this subject and its relation to public health. Strongly Agree	1. The Videoconference increased my understanding of this subject and its relation to public health. Agree	1. The Videoconference increased my understanding of this subject and its relation to public health. Neutral	1. The Videoconference increased my understanding of this subject and its relation to public health. Disagree	1. The Videoconference increased my understanding of this subject and its relation to public health. Strongly Disagree
2. The topics covered today were important and revelant to the issue of health disparities.	2. The topics covered today were important and revelant to the issue of health disparities. Strongly Agree	2. The topics covered today were important and revelant to the issue of health disparities. Agree	2. The topics covered today were important and revelant to the issue of health disparities. Neutral	2. The topics covered today were important and revelant to the issue of health disparities. Disagree	2. The topics covered today were important and revelant to the issue of health disparities. Strongly Disagree
3. I could see and hear clearly.	3. I could see and hear clearly. Strongly Agree	3. I could see and hear clearly. Agree	3. I could see and hear clearly. Neutral	3. I could see and hear clearly. Disagree	3. I could see and hear clearly. Strongly Disagree
4. I was able to ask questions easily.	4. I was able to ask questions easily. Strongly Agree	4. I was able to ask questions easily. Agree	4. I was able to ask questions easily. Neutral	4. I was able to ask questions easily. Disagree	4. I was able to ask questions easily. Strongly Disagree
5. Overall, the Videoconference was very valuable for me.	5. Overall, the Videoconference was very valuable for me. Strongly Agree	5. Overall, the Videoconference was very valuable for me. Agree	5. Overall, the Videoconference was very valuable for me. Neutral	5. Overall, the Videoconference was very valuable for me. Disagree	5. Overall, the Videoconference was very valuable for me. Strongly Disagree
6. I will highly recommend the Videoconferemce.	6. I will highly recommend the Videoconferemce. Strongly Agree	6. I will highly recommend the Videoconferemce. Agree	6. I will highly recommend the Videoconferemce. Neutral	6. I will highly recommend the Videoconferemce. Disagree	6. I will highly recommend the Videoconferemce. Strongly Disagree

7. Any comments about the speakers, topic, web site, and anything else, including suggestions for future years? Has the experience hd an impact on you that you would like to share?

8. If applicable, may we quote your comments publicly (e.g., on our website)?

Yes, by name
Yes, by location
No

9. Did you participate as part of a program?

NC Health Careers Access Program- (NC-HCAP)

Emerging Leaders in Public Health (ELPH)

UNC AGEP/ SPGRE/ RES

Biostatistics Undergraduate Research Experience ( B-SURE )

SUUPPRT

Other Program

Not with a program- came on my own

10. How did you learn about the Videoconference? (please check all that apply)

Minority Health Project web site (www.minority.unc.edu)
Other web site, please specify
Email from the Minority Health Project (mphannounce)
Email from another organization
Friend, colleague, coworker, or associate
Posted notice of poster
Professional organization's newsletter/ journal
Flyer handed out
Other, please specify

11. Where did you participate in the Videoconference?

Onsite at the TTate-Turner-Kuralt auditorium at the University of North Carolina School of Social Work
By computer (by myself or with one or two other people)
By computer (in a group) (If you organized the viewing, please complete the site facilitator evaluation form.)
At a satellite downlink site (please give the location)

12. Tell us about yourself. Please check all that apply.

Public health professional (health educator, public health nurse, health administrator,.etc)
Clinician (i.e. MD, nurse, physician's assistant, social worker, etc.)
Community Member
Faculty, teacher, or researcher
Student (undergraduate, graduate, doctoral)
Other ( Please specify)

Please provide your name, location, and email address.

Optional: Name

Optional: Location

Optional: Email address