Form 1 survey screenshot

HPV Cancer Center Consortium

Start of Block: Block 1

OMB No.: 0925-0648

Expiration Date: 06/30/2024

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

The goal of this survey is to assess interest in participating in future HPV Cancer Center Consortium activities and meetings and to identify topics of greatest interest. Please feel free to share this survey with others who may have an interest in HPV vaccination uptake.

How would you describe your professional role?*

• Researcher

• Clinician

• Public health practitioner

• Funding agency partner

• Other

Display This Question:

If How would you describe your professional role?* = Other

Please describe your professional role

________________________________________________________________

Did you attend the February 2023 meeting?*

• Yes

• No

Display This Question:

If Did you attend the February 2023 meeting?* = Yes

How helpful or informative were the following sessions in understanding HPV vaccination uptake?

	Not at all helpful/informative	Somewhat helpful/informative	Extremely helpful/informative	Did not attend
History and Recap of the HPV Cancer Center Consortium
Updates on National Immunization Survey-Teen HPV Vaccination Coverage
Consequences of COVID-19 for HPV Vaccine Implementation
Lessons Learned from Other Consortiums

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Start of Block: Block 2

As we start to plan for the Fall 2023 meeting: 

What topics would you like to see addressed?

________________________________________________________________

What would be your preferred meeting schedule?

• 2 half-days with dinner on Day 1

• 1 full day with dinner the night before

• 1 full day with dinner the night of the meeting

What meeting format do you prefer for Fall 2023?

______ In-person

______ Virtual

______ Hybrid

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Start of Block: Block 3

In order to help advance the Consortium:

What goals and objectives should the Consortium work towards?

________________________________________________________________

Who else would benefit from joining the Consortium?

________________________________________________________________

What support, collaborations, and resources are needed in order to enable participants to keep the momentum on Consortium action plans?

________________________________________________________________

Are you interested in leading any Consortium activities?*

• Yes

• No

Would you like to receive information about related Consortium webinars, initiatives, and activities?

• Yes

• No

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Start of Block: Block 4

For internal use only, please provide:

First and last name*

________________________________________________________________

Email address*

________________________________________________________________

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