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We appreciate your interest in Wisdom, Wellbeing & Peer Support Training!
Our HRSA grant requires regular reporting of training activities that includes information about participant characteristics, geographic location, and work environment. The WWPST team will use the de-identified information to analyze training data for required reports to HRSA.
Please select the location that best fits your role
UVA Health
UVA Student
Sentara Health
Community Partner
Other
Work Role - Which of the following best describes your current work or volunteer role?
Level 1 Front Line Workers and Program Staff
Level 2 Program Managers and Mid-Level Supervisors
Level 3 Senior Managers and Executive Leadership
Prefer not to answer
Professional Experience - How many years after training (i.e., graduation, certificate completion, etc.) have you been in practice?
0 years (in training)
1-5 years
6-10 years
11-15 years
16-20 years
More than 20 years
Prefer not to answer
Disadvantaged Background - Do any of the following pertain to your life experience?
1. Environment: I grew up in environment that inhibited me from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school
2. Financial: I grew up in a family with an annual income below a level based on U.S. Census Bureau low-income threshold.
3. Education: I grew up in a social, cultural, or educational environment that has demonstrably and directly inhibited me from obtaining the knowledge, skills, and abilities necessary to develop and participate in a health professions education or training program.
Yes
No
Prefer not to answer
Rural Background – Have you ever lived in a rural area?
Yes
No
Prefer not to answer
For this project, we must report professions by eight categories: (1) Allied Health (2) Behavioral Health (3) Dentistry (4) Medicine (5) Nursing (6) Paraprofessional (7) Public Health. Use (8) Other category in case your profession is not listed here. There are many sub-categories, or Disciplines, within each category. Please choose the profession and discipline (e.g., Nursing: Clinical Nurse Leader) that best fits your primary role.
Profession
Allied Health
Behavioral Health
Dentistry
Medicine
Nursing
Public Health
Paraprofessional
Other
Discipline
Please specify your age.
19 and Under
20-29 years
30-39 years
40-49 years
50-59 years
60 and Over
Prefer not to answer
Please specify your gender.
Female
Male
Non-Binary/Third Gender
Prefer not to answer
Please specify your race.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than one Race
Prefer not to answer
Please specify your ethnicity.
Hispanic/Latino
Non-Hispanic/Non-Latino
Prefer not to answer
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