Student Trainee Survey Student Trainee Survey What is today’s date? * (MM/DD/YYYY) What is your age range? * 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older What is the highest level of education/training you have completed or the highest degree you have received? * Less than high school High school diploma or equivalent (e.g., GED) Some college but no degree Associate degree Bachelor’s degree or higher What is your ethnicity? * American Indian or Alaskan Native Asian or Pacific Islander Black or African-American Hispanic or Latino White or Caucasian Prefer not to answer OtherOther In what zip code is your home located? (enter 5-digit ZIP code; e.g., 00544 or 94305) * How convenient is our location for you? * Extremely convenient Very convenient Moderately convenient Slightly convenient Not at all convenient How did you hear about the Schmieding Center for Senior Health and Education training classes? * Internet/Web search Through an agency who hires caregivers Word of mouth OtherOther What is your preference for class schedules? * 8:30am – 1pm daily (7 weeks of classes) 8:30am – 2pm daily (6 weeks of classes) 8:30am – 3pm daily (5 weeks of classes) 8:30am – 4pm daily (4.5 weeks of classes) 8:30am – 5pm daily (3.5 to 4 weeks of classes) OtherOther How did you pay for this class? * Self-pay Agency sponsorship Scholarship Combination of above options OtherOther Next Are there other aging education topics you suggest for our program? Please begin on a new line and number each new item. Are there other comments, questions, or suggestions you would like to share? Begin on a new line and number each new item. Submit
