Camp Med Pre-Program Survey
Provided by Northwest Area Health Education Center (Northwest AHEC), a program of Wake Forest School of Medicine and part of the NC AHEC System.
Participant Name
*
First Name
Middle Initial
Last Name
Participant Email Address
*
Confirmation Email
Please re-enter the email address to confirm.
HS Graduation Year
Parent/Guardian Name
*
First Name
Middle Initial
Last Name
Parent/Guardian Email Address
Confirmation Email
Please re-enter the email address to confirm.
Which Camp Med are you participating in?
*
Virtual
Live Camp Med summer program (North Carolina)
Please select your Camp Med summer program.
Please Select
Alexander
Alleghany
Ashe
Burke
Caldwell
Catawba CS
Catawba CVCC
Catawba Valley MC
Davidson County Schools
Davidson Lexington City
Davie
Forsyth- Career Center
Forsyth- Crosby Scholars
Forsyth- North Forsyth
Guilford
HA of the City of High Point
Iredell- North
Iredell- South
Rowan -Livingstone College
Stokes June 17-27 & June 24-27
Surry Northern Hospital
Surry County Summer Enrichment ( Non Camp Med)
Watauga
Wilkes
VolunTeens
School
City/Town
I am aware of a variety of health career options.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I am aware of the high school courses needed to pursue a health career.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I am aware of the high school courses required to attend a college or university in North Carolina.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I am aware of the duties and responsibilities of healthcare jobs for which I have an interest.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I would be more likely to choose a health career if I observed a healthcare professional.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I understand what social determinants of health (SDOH) are and why they are a critical component of the healthcare delivery system.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I understand the principals of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), medical ethics, and safety.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I am aware and can identify health profession shortages in my county.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Please verify all information above is accurate before clicking the 'Submit' button.
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