10-10145 SOU-SORCC Patient Survey

OMB No. 2900-0770

Estimated Burden: 10 Minutes

Expiration Date: XX/XX/XXXX

Southern Oregon University and Southern Oregon Rehabilitation Center and Clinics Program Offering Survey

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 10 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve improved mental health services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may currently be receiving.

Southern Oregon University and Southern Oregon Rehabilitation Center and Clinics Program Offering Survey

Informed Consent - Electronic Survey

Welcome to the Southern Oregon University and Southern Oregon Rehabilitation Center and Clinics program offering survey. Brad Christ of the Information Technology department at Southern Oregon University is conducting this research. The results of the survey will provide important information about your university experience and help create a better environment for working and learning.

No personal information will be collected. All information is strictly confidential and will be protected to the degree permitted by the technology used (e.g. IP addresses will be stripped when the survey is submitted).

Only group data will be reported, meaning the analysis will include only aggregate data. Results will be statistically compiled. No names will ever be used in any report of the results of this study. The aggregate data will be analyzed and may be presented at professional conferences.

If you have questions about the research project and/or you would like to see the results of this project, contact Brad Christ at (541) 552-6451 or christb@sou.edu

Your participation is voluntary and you may stop taking this survey at any time without penalty. The survey should take less than 5 minutes to complete. Please print a copy of this page for your records.

By continuing, you are confirming that you are at least 18 years old and are giving your informed consent to participate in the study.

How interested are you in taking courses from Southern Oregon University, whether on-campus, at Southern Oregon Rehabilitation Center and Clinics, or online?

• Very interested

• Interested

• Somewhat interested

• No interest

If you are interested in taking courses, what type(s) of programs would you like to enroll in?

• Non-degree seeking (classes only). All SOU courses are 10 weeks long.

• Certificate (1 to 2 years)

• Accelerated bachelor's degree (3 years)

• Bachelor's degree (4 years)

• Graduate degree (2 years, requires bachelor's degree)

• Other (please specify)

What areas of study are you most interested in?
(click and drag the areas of study from the left to the right)

Items Accounting Business Computer Science Communication Counseling Criminology and Criminal Justice Degree Completion Environmental Studies Marketing Nursing Psychology Outdoor Adventure Leadership Social Work

I am interested in:

Did we miss an area of study that you would like to see offered? If so, please list it below:

Where would you prefer to take courses from Southern Oregon University?

(select all that apply)

• At the SORCC campus in White City

• At the SOU campus in Medford

• At the SOU Campus in AShland

• Hybrid course that meets both on-campus (any location) and online

• Online

• Other (please specify)

For in-person courses, what times would be the most convenient for you to attend?

• 8am-5pm, Monday through Friday

• 5pm-10pm, Monday through Friday

• Weekend days

• Other (please specify)

When would you like to enroll in a program at SOU?

• As soon as possible

• In a month or two

• In three to four months

• In six months

• Over six months from now

• Other (please specify)

What are your long term educational and career goals? What courses, certificate, or degree will you need to achieve those goals?