Hospice Module Survey

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This online training was developed using funding from the Health Resources and Services
Administration (HRSA). As part of our grant requirement, we are required to collect
demographic and satisfaction data on trainees. If you are taking this training as an individual,
please complete our short survey (5 minutes) AFTER YOU HAVE FINISHED THE
TRAINING. If you are facilitating a group training, please distribute this survey to those in
attendance.

Likert Scale Key:

1) Strongly Disagree
2) Disagree
3) Neither Agree nor Disagree
4) Agree
5) Strongly Agree

Please enter your name

Email Address

Date Training Completed *

YYYY

I found the training met stated goals. *

I found the training met my educational needs. *

I found the training was engaging. *

I found the training was effective. *

I found the training has better prepared me to work in Long-Term-Care. *

Do you currently work in a Long-Term Services and Supports (LTSS) setting? *

Yes

If you do currently work in a LTSS setting, do you see yourself continuing to work in LTSS in the next 3 years? *

Yes

Please respond to your agreement to the following statements “after completing the training I am more interested in working in Long-Term Services and Supports” *

Please tell us what you learned from the training: *

Please tell us what you felt was missing from the training: *

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