Agromedicine Questionnaire Form

The North American Agromedicine Consortium (NAAC) is dedicated to integrating the medical sciences with traditional land-grant college agricultural science to develop more effective rural health initiatives. In states with active agromedicine programs, we have succeeded in establishing effective support groups and programs to accomplish the goals of agromedicine.

We wish to challenge interested agricultural and medical leadership in your state to begin development of an agromedicine dialog, with the main goal being to establish an agromedicine program in your state. Our organization is available to assist you with this, but we need you to identify a leader or leaders in your state to participate in this dialog. Experience has shown that a small group of dedicated leaders can provide the spark to bring this effective and innovative program to your state.

Please complete the following Interest Evaluation for NAAC. If you do not feel that you are the appropriate person to complete this evaluation, please ask someone in your state whom you feel may be interested in this program to complete this questionnaire. THANK YOU!

If there is no one whom you feel may be interested in this program in your state, we would appreciate a brief explanation:

Name:
State/Province:
Comments:

 

We appreciate your time and interest!

Questionnaire:

1. Are there any agromedicine opportunities that you recognize in your state?
2. Who are some of your professional colleagues in agricultural safety and health?
3. What groups or individuals do you think could be involved in developing an agromedicine program in your state?
4. Would you be able to recruit an interest group to assess this further with us?
Yes
No
Maybe
5. Is there interest in a consultative visit from members of our executive and outreach committees with your interest group?
Yes
No
Maybe
6. Please add your questions/comments ...
Name:
Title:
Agency:
Address:
Address:
City:
State/Province:
Zip Code:
Telephone: ( ) x
Fax: ( )
E-mail:

Thank you for taking the time and effort to consider becoming our colleague

Webmaster: Magdy Akladios, PhD, PE, CSP
Last modified: March 8, 2001