Educating America Tour Evaluation Form- Neptune, NJ How would you rate the conference overall? Excellent Very Good Good Fair Poor How would you rate the session "Brain Health Awareness, It’s Never Too Early” with Dr. Manisha Parulekar? Excellent Very Good Good Fair Poor How would you rate the session “The Impact of Alzheimer’s Disease on Language, Cognitive and Swallowing Function” with Josi Shimkus? Excellent Very Good Good Fair Poor How would you rate the session “How to Age in Place Safely” with Linda Chinman Pollock? Excellent Very Good Good Fair Poor After hearing about AFA's programs and services, which of the following are you likely to utilize in the future? Please check all that apply. Select All Call AFA's Helpline Get a virtual memory screening Attend another AFA educational conference Participate in an AFA professional training program Take part in a virtual activity program at the AFA Teal Room Is there a topic that was not covered today that you would like to see discussed at a future conference?Is there any other feedback or comments you would like to share about this conference?Name* First Last Email* Organization (if applicable) Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Δ
Educating America Tour Evaluation Form- Neptune, NJ How would you rate the conference overall? Excellent Very Good Good Fair Poor How would you rate the session "Brain Health Awareness, It’s Never Too Early” with Dr. Manisha Parulekar? Excellent Very Good Good Fair Poor How would you rate the session “The Impact of Alzheimer’s Disease on Language, Cognitive and Swallowing Function” with Josi Shimkus? Excellent Very Good Good Fair Poor How would you rate the session “How to Age in Place Safely” with Linda Chinman Pollock? Excellent Very Good Good Fair Poor After hearing about AFA's programs and services, which of the following are you likely to utilize in the future? Please check all that apply. Select All Call AFA's Helpline Get a virtual memory screening Attend another AFA educational conference Participate in an AFA professional training program Take part in a virtual activity program at the AFA Teal Room Is there a topic that was not covered today that you would like to see discussed at a future conference?Is there any other feedback or comments you would like to share about this conference?Name* First Last Email* Organization (if applicable) Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Δ
