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Disclosure:

The Indiana AHEC Network is required to report general demographic information about participants in the categories below. This data may be used for research purposes to evaluate the effectiveness of AHEC educational programs. Your participation is voluntary and will not affect your affiliation with IU, the Indiana AHEC Program, or its affiliates. As with any research there is always a small risk of loss of confidentiality. You are not expected to benefit from participation but we hope it informs our future AHEC educational programs. None of your personal information will be shared outside of our organization unless required by law.  If you have any questions about this program evaluation form, please reach out to ahecin@iupui.edu. For questions about your rights as a research participant, please contact the IU Human Research Protection Program office at 800-696-2949 or at irb@iu.edu.

Program Information

This should be provided to you.
Contact Information










Demographics


“Rural” encompasses all population, housing, and territory not included within an urban/city/metro area. Whatever is not urban is considered rural. Usually has a low-population density.
The AHEC Network uses the US Census designations for racial and ethnic origin identification.  For your convenience, we have included the US Census definitions for each racial and ethnic category.

Black or African American: can include those with origins from the Black racial groups of Africa
Native Hawaiian or Pacific Islander: can include those with origins from Guam, Samoa, and other Pacific Islands
White/Caucasian: can include those with origins from Europe, the Middle East, or North Africa.
American Indian or Alaska Native: can include those with origins from North/South/Central America who maintain tribal affiliation or community attachment.
Asian: can include those with origins from Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
More than one Race: can include those who identify as/with two (or more) of the categories identified above.

Hispanic/Latinx: Refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
Non-Hispanic/Latinx: Refers to those with no origins from Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture, regardless of race.



Individuals identifying as "Hispanic or Latino" are of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.


  • You are (or will be) the first generation/person in your family to attend college. 
  • You are a 21st Century Scholar or currently receive Scholarship or Loan for Disadvantaged Students.
  • While growing up, you or your family ever used federal or state assistance programs (such  as: free or reduced school lunch, WIC, subsidized housing, food stamps, Medicaid or Hoosier Healthwise, etc.).  
  • While growing up, you lived where there were few medical providers at a convenient distance.  
School Information






Before:

The following survey is designed to be a retrospective look at what you knew before this experience and what knowledge you have gained as a result of this program/experience.  This way of program survey is based on the principle "you don't realize how much you don't know". 


Please select the choice that best answers how much you agree with each statement BEFORE participating in this program/experience.









After

Please select the choice that best answers how much you agree with each statement AFTER participating in this program/experience.









Key Learning Takeaways




Evaluation of AHEC program, IRB # 2006213753