Immunization Pathway Training – CNE Evaluation Name * First Last Name * Last Credentials * HUB Training (choose one) Mahoning Valley Pathways HUB 6/13/17 Summit County Pathways HUB 6/28/17 Community Health Access Project HUB 11/20/17 Northwest Ohio Pathways HUB 12/15/17 Care Coordination Network (Columbus) 2/15/18 Health Care Access Now (Cincinnati) 1/9/17 Independant Study Email Address * Phone Number * Address * Address 2 City * State * ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * OBJECTIVES: At the conclusion of this activity, are you able to: Understand why immunizations are important * Yes No Learn the most common misconceptions about immunizations * Yes No Learn how to use established resources to educate families about immunizations * Yes No SPEAKERS: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. Speaker demonstrated teaching effectiveness: Michael Gittelman, MD, FAAP * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Elizabeth Barker, RN, BSN * 1 2 3 4 5 OVERALL PRESENTATION: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. The presentation was well organized and logically sequenced. * 1 2 3 4 5 The material was not too difficult to understand. * 1 2 3 4 5 I gained new information. * 1 2 3 4 5 How would you rate your overall satisfaction with this activity? * Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Additional Comments: By signing or typing your name, you confirm your identity and attest to attending the entire educational activity. * Clear If you are human, leave this field blank.