Question Title

* 1. Your role: (check all that apply)

Question Title

* 2. What type of leadership position do you hold within your organization?

Question Title

* 3. How would you describe the strength of your leadership skills?

Question Title

* 4. Have you participated in a public health (or dental public health) leadership program in the past?

Question Title

* 5. If yes, which program(s)?

Question Title

* 6. What platforms have you used for online learning (either presently or previously)? Of those you note, please indicate which you would recommend.

Question Title

* 7. Which formats or methods of learning do most prefer?

Question Title

* 8. Have you experienced any of the following types of leadership training or development? (select all that apply)

Question Title

* 9. What types of leadership training or development are offered at your current place of employment? (select all that apply)

Question Title

* 10. Rate your agreement with the statements below

  Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
Formal leadership training is important to advancing oral health equity. 
Leadership development should be a requirement in higher-level educational programs.
I have adequate opportunities to develop leadership skills within my organization.
I have adequate opportunities to develop leadership skills outside of my organization.
My current position allows me to focus on both personal and professional development.
My current network allows me to meet established leaders in my field. 

Question Title

* 11. What do you think are the most important competencies for effective public health leadership?

Question Title

* 12. Of the following topics, select your top five to receive training through a future leadership development program from AIDPH? (check only five)

Question Title

* 13. What top three skills would you hope to develop as part of a leadership program? (select only 3)

Question Title

* 14. Is 12 months the appropriate length for the program?

Question Title

* 15. How much would you be willing to pay to take part in the program? 

Question Title

* 16. Could your employer or another sponsor cover any program fees?

Question Title

* 17. Would you like to learn more about this AIDPH program as it is developed?

Question Title

* 18. What is the likelihood that you would apply to take part in this AIDPH program?

Question Title

* 19. Please select your gender (select all that apply):

Question Title

* 20. Please use this space to share any other thoughts on how AIDPH might design and offer a leadership development program focused on dental public health. 

T