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Geriatric Essentials eLearning
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First Name*
Last Name*
Email*
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Organization
Postal Code
Level of Education Completed
Primary School (less than or up to grade 8)
Some Secondary/High School (less than or up to grade 12)
Secondary/High School Diploma (or GED)
Some college/university
College Program (diploma, trades certificate and/or apprenticeship)
Bachelor’s Degree
Master’s Degree
Doctorate
Other
If Other, Please Specify
Discipline
Nurse
Personal Support Worker
Resident Support Aide
Behavioural Therapist/Analyst
Occupational Therapist
Physical Therapist
Recreation Therapist
Speech/Language Pathologist
Social Worker
Gerontologist
Other health-related discipline:[single text field]
Physician
Other
If Other, Please Specify Discipline
Role
Direct Healthcare Provider
Team Leader
Quality Improvement/Risk Management Consultant/Facilitator
University/College Researcher
Professor/Educator
Administrator/Manager
Family Care Partner/Person with lived experience
Student
Other
If Other, Please Specify Role
Years of Experience working in Geriatrics
Less than a year
1-5
6-10
11-15
16+
Not applicable
Healthcare Sector
Long-Term Care
Community (incl. Adult Day Program, Retirement Homes)
Acute Care
Primary Care
Other
Not Applicable
Preferred Language
English
French
Other
If Other, Please Specify (Language)
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