Dream Big-GHW Module 4 Pre-Tests and Surveys

Module 4:

Barriers to Vaccination and Navigating People to Vaccine Services

PRE-course Survey Questions

Please take this prior to viewing the presention.

Date*

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/Promotor(a).Yes, I am a CHW instructor.I 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?*

Do you routinely help connect people in your community to vaccine services?*

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 connect people to vaccine services?*

OPTIONAL: What type(s) of communities do you serve?