Caregiver Training Survey

What is today's date? * Required
(MM/DD/YYYY)
MM slash DD slash YYYY
Enter your birthday * Required
(MM/DD/YYYY)
MM slash DD slash YYYY
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 class are you taking now? * Required
Mark the current or most recent class
- In-Home Assistant
- In-Home Assistant - Independent Study
- Alzheimers/Dementia
- Alzheimers/Dementia - Independent Study
- Home Care Assistant
- Family Caregiver Workshop - Dementia
- Family Caregiver Workshop - Basic Skills
- CNA Fast Track (91 hours)
Where is this class located? * Required
Mark the location where you are tested or demonstrate skills
- at the Schmieding Center (Springdale)
- at the Veterans Administration
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
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

Do you have comments, questions, or suggestions about the registration process for this class?
Please begin on a new line and number each new item.
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.