2023 Veteran's Mental Health Summit

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.
The program number must begin with "EE-" followed by the programs unique 6 digit number.  Example: EE-000000
Contact Information










Demographics
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.


“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.

Employment Information










Are you employed in any of the following areas?

In general, a rural area or countryside is a geographic area that is located outside towns and cities. Typical rural areas have a low population density and small settlements. Areas with large amounts of agricultural are commonly rural, as are other types of areas such as forests.

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need.

Medically Underserved Areas/Populations are areas or populations designated as having too few primary care providers, high infant mortality, high poverty or a high elderly population

Evaluation of AHEC program, IRB # 2006213753

Contact Information