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Thank you for taking the time to complete this brief survey!

Last Name

First Name

UVA Email Address (i.e. lc6be@virginia.edu)

Cell Phone #

Where do you currently live? (city)

Where did you complete your associate's degree or diploma program?

When did you graduate from your initial nursing program?

Are you currently employed?

Yes
No

Where do you work? Please include the unit.

If you work at UVA Health System, are you currently enrolled in the Nurse Residency Program?

Yes, I am currently enrolled in the NRP.
No
I do not work at UVA Health System.

Are you fluent in any other languages?

Yes
No

Which language(s)?

Please list any hobbies or interests you would like to share with us.

Please rate your abilities in the following skill areas:

Please rate your abilities in the following skill areas:
	Excellent	Good	Average	Poor	Terrible	Not sure
Study skills	Excellent	Good	Average	Poor	Terrible	Not sure
Note-taking	Excellent	Good	Average	Poor	Terrible	Not sure
Academic Writing	Excellent	Good	Average	Poor	Terrible	Not sure
Presentation/Oral Communication	Excellent	Good	Average	Poor	Terrible	Not sure
Time Management	Excellent	Good	Average	Poor	Terrible	Not sure
Stress Management	Excellent	Good	Average	Poor	Terrible	Not sure
Sleep management	Excellent	Good	Average	Poor	Terrible	Not sure
Reading comprehension	Excellent	Good	Average	Poor	Terrible	Not sure
Working effectively in groups	Excellent	Good	Average	Poor	Terrible	Not sure
Leadership	Excellent	Good	Average	Poor	Terrible	Not sure

What are you most concerned or worried about academically?

Please share with us why you chose our program.

Is there anything else about your transition into the RN to BSN program that worries you?

What excites you most about beginning the RN to BSN program?

Is there anything else about yourself that you’d like to share, or that you think we should be aware of, which will help us support you in our program?