User Survey

User Survey

Before you enter this area of the University of California, San Francisco Academic Geriatric Resource Center (UCSF AGRC) Online Curriculum, we need to ask you the following questions.

Please note: Required information is indicated by a *.
In addition, your browser must accept cookies to avoid repeatedly
seeing these survey questions during your session.

1. What is your affiliation? (Please enter the name of your university, institute, etc.) *

2. What is your role? (Please choose one option from the menu)

*

3a. What is your name?
(Optional)

3b.What is your email address?
(Optional)

4. If you answered "Faculty" in question #2 above:

4.a. Are you using these modules in your teaching? Yes No

4.b. If so, which course(s) and what disciplines and/or levels (i.e. undergraduate, graduate, resident, doctoral, etc.) are represented among the students in this course?

If you answered "Student" in question #2 above:

4.a. Have you been assigned these modules as part of a course of study? Yes No

4.b. If so, what is the course, and what is your discipline and your level (i.e. undergraduate, graduate, resident, doctoral, etc.)?

5. Do you have any comments?

Please note: Required information is indicated by a *

Please give us your feedback and complete our online user evaluation when you have completed one or more of the modules. Click to go directly to the user evaluation.

Your privacy is important to us!

Disclaimer: The sole purpose of collecting information is to allow for more accurate reporting to our funding agencies and governing bodies. Your submission will not be shared with any third parties. Thanks very much for your support.

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Visitors to this site must accept these Terms of Use.

Please note: Required information is indicated by a *. In addition, your browser must accept cookies to avoid repeatedly seeing these survey questions during your session.
1. What is your affiliation? (Please enter the name of your university, institute, etc.)		*
2. What is your role? (Please choose one option from the menu)		*
3a. What is your name? (Optional)
3b.What is your email address? (Optional)
4. If you answered "Faculty" in question #2 above:
	4.a. Are you using these modules in your teaching?	Yes No
	4.b. If so, which course(s) and what disciplines and/or levels (i.e. undergraduate, graduate, resident, doctoral, etc.) are represented among the students in this course?
If you answered "Student" in question #2 above:
	4.a. Have you been assigned these modules as part of a course of study?	Yes No
	4.b. If so, what is the course, and what is your discipline and your level (i.e. undergraduate, graduate, resident, doctoral, etc.)?
5. Do you have any comments?
Please note: Required information is indicated by a *

Please give us your feedback and complete our online user evaluation when you have completed one or more of the modules. Click to go directly to the user evaluation.