1.  What is your specialty?  

2.   How many years in practice?  

3.  Are you certified?   Yes No

4.  If yes, indicate the area(s) of certification?  

5.  If no, do you plan on becoming certified?   Yes No

6.  What is the highest degree you have earned?   Diploma Associate Bachelor's Master's Doctorate

7.  For those who don't have a BSN, are you considering this degree? Yes No

8.  How do you meet the various states' mandatory continuing education requirements? (Rank your preference beginning with 1 as your most preferred):

conferences conventions seminars workshops home study videos audio cassettes other

9.  What per - contact hour price range do you usually pay for CE programs? $50 - $100 $100 - $150 $150 - $200 over $200

10.  Identify your top 5 CE learning needs?

A.

B.

C.

D.

E.

11.  Do you prefer to attend courses during the week over the weekend a combination of both

12.  Would you like to be added to the Cross Country University's mailing list?  
Yes No

13.  Have you ever published?   Yes No

14.  Have you ever been a speaker?   Yes No

15.  Would you like to perform book reviews? Yes No