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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 Institute and Videoconference on Minority Health

Participant Evaluation Form

Please tell us about your Videoconference experience. (If you were unable to view the Videoconference, please skip to item 7 and tell us whether the reason was due to scheduling or technical problems.)

Please tell us about your Videoconference experience. (If you were unable to view the Videoconference, please skip to item 7 and tell us whether the reason was due to scheduling or technical problems.)
			Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
1. The Videoconference increased my understanding of this subject and its relation to public health.
2. The topics covered today were important and revelant to the issue of health disparities.
3. I could see and hear clearly.
4. I was able to ask questions easily.
5. Overall, the Videoconference was very valuable for me.
6. I will highly recommend the Videoconference.

7. Any comments about the speakers, topic, web site, or anything else, including suggestions for future years? Has the experience had an impact on you that you would like to share? Would you like to give a testimonial we can use in publicity and funding requests?

8. 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

9. Did you participate as part of a program?

Yes, please specify
No

10. Where did you participate in the Videoconference?

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

11. If you viewed the videoconference with a group, please tell us the City, State and Zipcode where you viewed the broadcast.

City
State
Zipcode

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 so we'll know you've responded.

Optional: Name
Optional: Email address