Module 2 Pre-Tests and Surveys

Module 2:

The Past, Present, and Future of Vaccination

PRE-course Survey Questions

Please take this prior to viewing the presention.
Date*

MonthDayYear
Date
Enter Full Name*
Zip Code*
Email*
example@example.com
Are you a Community Health Worker/Promotor(a) or CHW instructor? Please select all that apply

Yes, I am a Community Health Worker/PromotorYes, I am a CHW instructorI am not a Community Health Worker/Promotor(a)or a CHW instructor. Just here to learn!
Do you routinely talk to people in your community about vaccines?*

YesNoUnsure
OPTIONAL: If so, how?
On a scale of 1 (not at all confident) to 10 (very confident), how confident are you in your ability to talk about vaccines with others in your community?*
OPTIONAL: What type(s) of communities do you serve?