OCAM Network Technical Assistance Evaluation Form
This form is intended to be filled out by any individual who has received technical assistance from an OCAM Coach. Technical assistance may include help with your Professional Development Plan, finding domain specific courses, or answering any prevention credentialing questions you may have. Filling out this form helps the OCAM Network have a better idea of how we can best assist you and your professional development goals. Thank you for your time and if you need any other assistance, please email info@ocamnetwork.org!
Name
First Name
Last Name
Email
example@example.com
What is your race?
*
White or Caucasian
Black or African American
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Multiracial
Other
What is your ethnicity?
*
Hispanic or Latino
Non-Hispanic
Appalachian
What is your age?
*
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65+
What is your gender?
*
Male
Female
Non-Binary
Other
I prefer not to answer
Which county/counties do you work in?
*
Which prevention credential do you already have?
*
Registered Applicant (RA)
Ohio Certified Prevention Specialist Assistant (OCPSA)
Ohio Certified Prevention Specialist (OCPS)
Ohio Certified Prevention Consultant (OCPC)
I do not have any prevention credentials
If you are currently pursuing a prevention credential, please indicate which one.
*
Registered Applicant (RA)
Ohio Certified Prevention Specialist Assistant (OCPSA)
Ohio Certified Prevention Specialist (OCPS)
Ohio Certified Prevention Consultant (OCPC)
I am not pursuing a credential at this time
What type of technical assistance did you receive from an OCAM coach? (click all that apply)
*
Professional development plan
Prevention credentialing
Continuing education
Questions about supervision
One-on-one coaching
Test prep (study groups)
The OCAM coach was able to address and answer all my questions.
*
1
2
3
4
5
Disagree Agree
I would recommend OCAM's technical assistance to another prevention professional.
*
1
2
3
4
5
Disagree Agree
How could an OCAM coach assist you further? Do you need additional prevention related support?
Please explain
Additional comments about your OCAM technical assistance experience:
Submit
Should be Empty: