Spring Education Meeting 2026 Evaluation

Participant Contact Information

Name

Credentials

Such as MD, RN, etc.; if not applicable, leave blank.

Practice or Organization

Email Address

Your CME certificate will be sent to this address.

Phone Number

Address

City

State

Zip

If seeking MOC Part 2 credit, please enter your ABP diplomate number:

If seeking MOC Part 2 credit, please enter your date of birth (MM/DD/YY):

End Year for Current MOC Cycle:

Specialty

Activity Evaluation

Please select the reason (or reasons) that you chose to access this activity:

MOC Part II Credit

CME Credit (or Other Continuing Education Credit)

Educational Content/Topic

Speaker

OtherOther

What is one new piece of information from this education session you feel is the most impactful to your practice?

As a result of this activity, do you plan to make changes in practice?

Yes

No

Based on what you learned in this session, which of the following changes will you make to your practice?

Educate appropriate staff

Use new resources for patient visits

Expand knowledge of topic through research

Make changes to practice work flow (Please provide example if possible)Make changes to practice work flow (Please provide example if possible)

OtherOther

Assess your level of commitment to making the modification to your practice stated above:

Very committed

Committed

Somewhat committed

Not very committed

Do not expect to change practice

As you look ahead, what CME topic is your highest learning priority?

Please rate the following statements based on your opinion following this education session.

This activity was free of bias and promotes the values of belonging, respect and fairness.

Yes

No (if no, please comment)No (if no, please comment)

This activity was free of commercial bias.

Yes

No (if no, please comment)No (if no, please comment)

Faculty disclosures were made.

Yes

No (if no, please comment)No (if no, please comment)

How can the Ohio AAP assist in meeting your educational needs?

If you have an advocacy initiative or Ohio legislative update to share with members of the Ohio AAP and/or attendees from today’s meeting, please include a brief paragraph on your initiative that will be compiled and sent to all attendees. Remember to include your contact information for follow-up.

Please share the above with the following audiences (check all that apply):

Ohio AAP Members in our e-news

Advocacy Day attendees

Please check the objective(s) that you feel were met today. Check all that apply.

Apply advocacy tools and resources to engage with legislators and stakeholders during structured advocacy activities.

Determine the most appropriate action plan for your level of skill, interest and capacity to make an impact in advocacy.

Discuss the current child health landscape in Ohio, including emerging challenges, misinformation, and policy-related barriers to care.

Would you like to become more involved in Ohio AAP advocacy efforts?

Yes

No

Unsure, but would like to learn more

How did your participation in this activity impact your comfort level and confidence when engaging in advocacy?

What changes do you plan to implement in your practice or advocacy activities over the next 90 days?

Signature

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