A Public Health Response to Trauma: Creating Conditions, Connection and Community for Women and Families

Form approved

OMB # 0990-0379

Expires 07/31/2014

Comment Card for Soliciting Feedback on

“A Public Health Response to Trauma:

Creating Conditions, Connection and Community for Women and Families” Training Curriculum

Comments Part 1: We welcome your feedback on the training curriculum “A Public Health Response to Trauma: Creating Conditions, Connection and Community for Women and Families.”

For each statement below circle the number as it applies to your experience of this training using the following scale.

1= Strongly disagree; 2= Disagree; 3= Neither agree nor disagree; 4= Agree; 5= Strongly agree

A) This training provided me with useful new knowledge.

1 2 3 4 5

Strongly Neither agree Strongly

Disagree Disagree nor disagree Agree Agree

B) This training provided me with useful new skills.

1 2 3 4 5

Strongly Neither agree Strongly

Disagree Disagree nor disagree Agree Agree

C) The trainers provided appropriate training materials.

1 2 3 4 5

Strongly Neither agree Strongly

Disagree Disagree nor disagree Agree Agree

D) I can apply information from this training to my work.

1 2 3 4 5

Strongly Neither agree Strongly

Disagree Disagree nor disagree Agree Agree

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-XXXX. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.

Comments Part 2: Give us additional feedback. Please respond to the following:

A) Name 4 things you’ve learned that align with your beliefs.

B) What are 3 things you are still wondering about?

C) Identify 2 things that you will put into practice.

D) What’s the 1 most important thing that you learned?

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