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The University of North Carolina at Chapel Hill

Program for Ethnicity, Culture, and Health Outcomes (ECHO)
Minority Health Project

Men’s Health Disparities: Implications for Research and Intervention

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

Site Facilitator Evaluation Form

1. In what city and state/country was your viewing site located?

City
State/Country

2. What is your site identification number?
(The Site ID is in parenteses immediately after the name of your site at http://minority.unc.edu/institute/2008/satellite/sites.cfm; The SiteID is usually the 9-digit postal code for the viewing location.)

Site ID number

3. What was the total number of participants at your site?

Number of Participants

4. Were your participants (Check all that apply)

	Public health professionals (health educators, public health nurses, health administrators, etc.)
	Clinicians (i.e. doctors, nurses, physician assistants, social workers, etc.)
	Community Members
	Faculty, teachers, researchers
	Students (undergraduate, graduate, doctoral)
	Other
	No participants- just taping

5. How did you recieve the broadcast?

	Satellite
	Webcast

Did you experience any problems receiving the broadcast?

6. Were the participants able to ask questions conveniently (check all that apply):

by telephone	by webform	by email

7. Was the time allocated for presentations:

too little	about right	too much

8. Was the time allocated for questions and comments:

too short	about right	too long

Please rate each of the following as

**Please rate each of the following as**
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
9. Participants at my site seemed engaged during the broadcast.
10. Participants found the material interesting and important.
11. Participants at my site felt able to ask questions.
12. The web site was well-organized, convenient, and informative.
13. Compared to others, this broadcast was well organized and well run.
14. I will recommend this broadcast to other organizations.
15. My organization would like to be a site for the broadcast in 2009.
16. I would like to be a site facilitator for similar events in the future.
17. Overall, I think the Videoconference was time well spent.

18. Any comments about the speakers, topic, the web site, and anything else, including suggestions for future years? Would you like to provide a testimonial for us to use?

19. If applicable, may we quote your comments publicly (e.g., on the web)?

	Yes, by name
	Yes, by location
	No

20. So that we can know who has responded and ask a clarification question if necessary, please provide:

Name
Email address