Pinoy RH Member's Profile Form

Instruction for filling up:
1. Please copy the entire post then paste this to a blank email.
2. Answer the questions by typing "X" inside the box opposite the answers.
3. Some questions may require that you type your answers, please take time to do so.
4. Review your answers.
5. Send the email to noemi.leis@hain.org.

I. PERSONAL INFORMATION AND ORGANIZATIONAL PROFILE
Name:
Nickname:
Name of Organization:
Address of Organization:
Telephone:
Fax:
Email:
Website:
Type of Organization:
[ ] Government
[ ] NGO
[ ] academic/research institution
[ ] private/business organization
[ ] religious organization
[ ] others, please specify:

Please choose three categories that best describe the activities of your
organization
[ ] health care services
[ ] training
[ ] teaching
[ ] health education
[ ] community development
[ ] publications
[ ] library/information services
[ ] research
[ ] policy making/planning
[ ] advocacy
[ ] counseling
[ ] others, please specify:

Geographical scope:
[ ] Local (within the province, city or municipality)
[ ] National
[ ] Regional (e.g., Asia-Pacific)
[ ] International

Client/Target groups of your organization
[ ] children
[ ] injecting drug use
[ ] ethnic community
[ ] MSM
[ ] sex workers
[ ] people living with HIV/AIDS
[ ] adolescents
[ ] women
[ ] men
[ ] others, please specify:

What is your occupation?
[ ] clinical doctor/physician
[ ] nurse
[ ] midwife
[ ] community health worker
[ ] health educator/promoter
[ ] traditional healer/TBA
[ ] community/youth/social worker
[ ] academic (professor, instructor, etc.)
[ ] media practitioner
[ ] others, please specify:

II. IT Background
A. How often do you write/check email?
[ ] Twice a day [ ] Once a day [ ] Others:
B. Do you access the Internet? [ ] Yes [ ] No
How often? [ ] Daily [ ] As need arises [ ] Others:
C. Do you use search engines in locating information, e.g., Google, Yahoo,
Alta Vista, etc.
[ ] Yes [ ] No
D. Have you experienced any of the following? (Please mark more than one)
[ ] Searching
[ ] Chat
[ ] FTP (File transfer protocol)
[ ] Sending an attached file
[ ] Downloading of files
[ ] Others, please specify:
E. Do you subscribe to other mailing lists other than PinoyRH? [ ] Yes [ ] No
Please list them down:
1.
2.
3.
F. Have you posted any of the following to PinoyRH?
[ ] Press release
[ ] Announcement
[ ] Question
[ ] Article/s
[ ] Replies/Feedback
[ ] Others, please specify:
G. Do you find PinoyRH helpful to your work? [ ] Yes [ ] No
Why?
H. Do you have any difficulties writing/posting a message for PinoyRH? [ ]
Yes [ ] No
I. Do you need any technical assistance in posting a message (e.g., cut and
paste technique, connecting, dialing, etc.)?