JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Va-LEND Module Evaluation-Restraint and Seclusion
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
What is your role in working with children/families with special health care needs/disabilities? (For example: Occupational Therapist, Social Worker, Special Education, Parent, Self Advocate, etc.)
*
Your answer
What is your zip code?
*
Your answer
Date Module Completed
*
MM
/
DD
/
YYYY
I increased my awareness of the health care needs of children with autism spectrum disorder, developmental disabilities, and other special needs.
*
Strongly Disagree
1
2
3
4
Strongly Agree
I increased my awareness of interdisciplinary, family-centered, culturally/linguistically competent, evidenced-based and community-based approaches to services and supports.
*
Strongly Disagree
1
2
3
4
Strongly Agree
In what ways might you use what you’ve learned from this module?
*
Your answer
Name three of the things you enjoyed learning the most about:
*
Your answer
What is your overall level of satisfaction with this module?
*
Highly dissatisfied
1
2
3
4
Highly satisfied
Thank you!
Thank you for completing the evaluation. Your certificate will automatically be emailed to you as an attachment upon submission of this form.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Virginia Commonwealth University.
Report Abuse
Forms
