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Schmieding Center - Springdale
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Home Caregiver Training Class Registration
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Schmieding Center - Springdale
Home Caregiver Training Class Registration
Home Caregiver Training...
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Enter your birthday
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Name
*
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First
Last
Email
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Phone
*
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Email
*
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Phone
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Residence County
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Benton
Washington
Baxter
Boone
Carroll
Izard
Marion
Newton
Searcy
Stone
Other
Profession
*
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Public/Community
Dietician
Medical Student
Nursing
Nursing Home Administration
Paraprofessional
Patient
Physical Therapy
Physician
Resident
Social Work
Student
Gender
*
Required
First Choice
Male
Female
Other
Race
*
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African-American
American Indian
Asian/Pacific Islander
Caucasian
Hispanic
Middle Eastern
Other
How did you learn of this program?
(check all that apply)
Facebook
Website
Word of mouth
My Center on Aging (Schmieding Center)
My healthcare provider (e.g., doctor, nurse, etc.)
Other
Survey data is required by our funder to offer this program at no cost to participants. Only aggregate (group) data from this survey is reported.
How did you hear about caregiver training classes from the Schmieding Center?
*
Required
Internet/web search
Agency referral
Word of mouth
Sign at the Schmieding Center
Newspaper/Magazine Ad
Other
What best describes your reason for taking this class?
*
Required
I plan to work as a paid caregiver
I am caring for a friend or family member
Other
Based on your current knowledge of this class, do you believe that the class content will enable you to fulfill your role as a paid or family caregiver?
*
Required
Yes
No
Cannot judge at this time
Other
How would you rate your current knowledge of caregiving topics?
*
Required
Very High
High
Average
Low
Very Low
How would you rate your current understanding about aging topics?
*
Required
Very High
High
Average
Low
Very Low
How confident are you using a gait belt?
*
Required
Very High
High
Average
Low
Very Low
No confidence
How confident are you giving a bath to an immobile person?
*
Required
Very High
High
Average
Low
Very Low
No confidence
Rate your current skill level in transferring a dependent person?
*
Required
Very High
High
Average
Low
Very Low
No skill
Rate your current ability to care for a person with memory impairment?
*
Required
Very High
High
Average
Low
Very Low
No ability
How confident are you providing person-centered care for an older adult?
*
Required
Very High
High
Average
Low
Very Low
No confidence
Rate your ability to dress a person who requires assistance?
*
Required
Very High
High
Average
Low
Very Low
No ability
How would you rate your current understanding of chronic disease?
*
Required
Very High
High
Average
Low
Very Low
Which answer best describes your current level of confidence caring for an older adult?
*
Required
Very High
High
Average
Low
Very Low
Do you have comments, questions, or suggestions about the registration process for this class?
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Are there other aging education topics you suggest for our program?
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Are there other comments, questions, or suggestions you would like to share?
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