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The University of North Carolina at Chapel Hill

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

Breaking the Cycle: Investigating the Intersection of
Educational Inequities and Health Disparities

15th Annual Summer Public Health Research
Videoconference on Minority Health

Site Facilitator Evaluation Form

1. Where was your viewing site located?

City
State/Country
Zip Code

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

Number of Participants

3. 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

4. How did you receive the broadcast?

Satellite
Webcast

5. Did you experience any problems receiving the broadcast?

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

by telephone	by webform	by email

7. Was the time allocated for presentations:

too short	about right	too long

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 next Annual Videoconference.
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, web site, or anything else, including suggestions for future years? Would you like to provide a testimonial for us to use in promotion or fundraising?

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