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UNC Gillings School of Global Public Health

Minority Health Project

Early Childhood Development: Investing in Our Children and Our Future
19th National Health Equity Research Webcast

Participant Evaluation Form

1. So that we can know who has responded and to enter you into the drawing for a $10 gift certificate (or DVD), please provide:

Name

Email address

(would you like to receive email announcements (up to 10/year)

2. Please tell us the City, State/Country and Zipcode where you viewed (or tried to view) the broadcast.

City

State/Country

Zipcode

3. How did you learn about the Webcast? (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 or poster
Professional organization's newsletter/ journal
Flyer handed out
Other, please specify

Please tell us about your Webcast experience. (If you were unable to view the Webcast, please skip to item 8 and tell us whether the reason was due to scheduling or technical problems.)

**Please tell us about your Webcast experience. (If you were unable to view the Webcast, please skip to item 8 and tell us whether the reason was due to scheduling or technical problems.)**
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
4. The Webcast increased my understanding of this subject.	4. The Webcast increased my understanding of this subject. Strongly Agree	4. The Webcast increased my understanding of this subject. Agree	4. The Webcast increased my understanding of this subject. Neutral	4. The Webcast increased my understanding of this subject. Disagree	4. The Webcast increased my understanding of this subject. Strongly Disagree
5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities	5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities Strongly Agree	5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities Agree	5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities Neutral	5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities Disagree	5. The topics covered today were important and relevant to the issue of education, health, and other types of disparities and inequities Strongly Disagree
6. Overall, the Webcast was very valuable for me.	6. Overall, the Webcast was very valuable for me. Strongly Agree	6. Overall, the Webcast was very valuable for me. Agree	6. Overall, the Webcast was very valuable for me. Neutral	6. Overall, the Webcast was very valuable for me. Disagree	6. Overall, the Webcast was very valuable for me. Strongly Disagree
7. I will highly recommend the Webcast.	7. I will highly recommend the Webcast. Strongly Agree	7. I will highly recommend the Webcast. Agree	7. I will highly recommend the Webcast. Neutral	7. I will highly recommend the Webcast. Disagree	7. I will highly recommend the Webcast. Strongly Disagree

8. Where did you view/participate from?

Studio audience (at the Tate-Turner-Kuralt auditorium at the University of North Carolina School of Social Work)
Via webcast on a computer monitor (by myself or with one or two other people)
Via webcast on a computer projector display (or with 3 or more other people)

9. Did you participate as part of a program?

Yes, please specify (NC-HCAP, MED, BSURE, etc.)
No

10. Are you (please check all that apply):

Public Health Practitioner
Teacher
Administrator
Clinician (i.e. MD, nurse, physician assistant, etc.)
Community Member/Community Organization
Faculty/Researcher
Student
Non-Profit/Policy/Government/Social Services Worker
Other, please specify

11. What did you like most about the webcast?

12. What suggestions do you have for future webcasts?

13. Are there any other comments about the webcast that you would like to share with the planning committee?

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

Yes, by name (please "sign" your comment with what you would like us to use)
Yes, by location
No

Do you want to print a certificate of attendance?

Yes (This option will redirect you to the certificate site)
No (This will take you to the end of the survey)