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Registration: Communicable Disease: Public Health Response and Investigation November 22, 2016

Webinar Registration

This is the registration form to view our livestream program, 'Communicable Disease: Public Health Response and Investigation' on Tuesday, November 22nd at 10:30 am. The speaker is Sonya E. Frontin, MPH, an Epidemiologist in the Communicable Disease Service of the New Jersey Department of Health.

The Public Health Core Competencies to be addressed include: 1B4, 1B5, 6B1 and 6B3.
(Selected from: http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf)

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email Address. Please enter (and review!) this carefully as the links to view and evaluate this program will be emailed to you. *This question is required.

4. Job Title *This question is required.

5. Organization *This question is required.

6. Which is the U.S. state/ territory/ commonwealth where you work? *This question is required.

7. Please select your employment setting (check all that apply) *This question is required.

Primary Care
Medically Underserved Community
Rural Area
None of the above

8. Please select your primary profession/discipline. *This question is required.

9. How confident are you that you can: *This question is required.

Space Cell	Not at all confident	Somewhat confident	Moderately confident	Very confident
Describe public health principles and the structure of public health at the federal, state and local level	Describe public health principles and the structure of public health at the federal, state and local level: Not at all confident	Describe public health principles and the structure of public health at the federal, state and local level: Somewhat confident	Describe public health principles and the structure of public health at the federal, state and local level: Moderately confident	Describe public health principles and the structure of public health at the federal, state and local level: Very confident
Explain how local and state public health partners and New Jersey state laws and regulations guide communicable disease response and investigation	Explain how local and state public health partners and New Jersey state laws and regulations guide communicable disease response and investigation: Not at all confident	Explain how local and state public health partners and New Jersey state laws and regulations guide communicable disease response and investigation: Somewhat confident	Explain how local and state public health partners and New Jersey state laws and regulations guide communicable disease response and investigation: Moderately confident	Explain how local and state public health partners and New Jersey state laws and regulations guide communicable disease response and investigation: Very confident
Review a case study of a communicable disease outbreak using applicable public health and epidemiology principles	Review a case study of a communicable disease outbreak using applicable public health and epidemiology principles: Not at all confident	Review a case study of a communicable disease outbreak using applicable public health and epidemiology principles: Somewhat confident	Review a case study of a communicable disease outbreak using applicable public health and epidemiology principles: Moderately confident	Review a case study of a communicable disease outbreak using applicable public health and epidemiology principles: Very confident

10. Please select the reason you are attending this webinar (please select all that apply) *This question is required.

to learn more about the specific webinar topic
the webinar topic relates to my work
general interest in staying informed about public health practice
general interest in staying informed about current public health research
to obtain continuing education credits
Other (please specify) Please enter an 'other' value for this selection. * This question is required.