1. What is your highest level of education?	- Select One - LPN RN BSN MSN Ph.D. Other [required]
2. Current Job Title	[required]
3. Area of Practice	[required]
4. Which format and time of day would you prefer to attend continuing education program?	- Select One - All Day Half Day (AM) Half Day (PM) Evenings Multiple Days [required]
5. Which day(s) of the week would you most likely attend a continuing education activity?	Monday Tuesday Wednesday Thursday Friday Saturday
6. Are you interested in online Web based course work?	Yes No [required]
7. If Yes - what one continuing education topic would you like to see provided?
8. Please review the list of potential continuing education topics below. Select those in which your need or interest is high.	Anesthesia Bedside Leadership Business of Nursing Cardio Care Critical Care Diabetes Ethics Geriatrics Going Wireless Med-Surg Neo-Natal Nursing Administration Occupational Health Obesity Pediatrics Pharmacology Physical Assessment Refresher Psychiatric/Mental Health Urology Women's Health Other:
9. What do you believe is a reasonable fee for:	Online Programs: On Campus Programs: CEU Credits:
10. How many miles would you be willing to go if you are willing to travel to attend programs?
11. Please provide an e-mail address if we may contact you for further program inquiries and updates
12. Comments