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* 1. My primary work environment is:

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* 2. The shift I primarily work is:

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* 3. I've been in my current role for

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* 4. My role is

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* 5. Clinical Education Topics I'm interested in (select up to three topics):

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* 6. Patient Care topics I'm interested in (select up to three topics)

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* 7. Patient Safety topics I want to learn about (pick up to three topics)

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* 8. Disease Process Topics I'm interested in learning about (pick up to three topics)

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* 9. Professional Practice Topics I want to learn more about (select up to three topics)

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* 10. Professional Development Topics I'm interested i learning more about (select up to three topics)

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* 11. Research and Evidence-Based Practice Topics I'm interested in learning more about (select up to three topics)

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* 12. My learning preferences

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* 13. I prefer education to be

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* 14. I think the ideal length for education courses is:

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* 15. These are the barrier's I've encountered when participating in education/professional development activities:

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* 16. Please provide any additional comments or input you think are important for the Clinical Education team to know about.

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