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Training
- Dementia Friendly Training
- Elder Abuse Training
Certification
Resources
Contact

Form Test

1. Trainee Name
Trainee Name*
First Last
2. Training Date
Training Date*
MM slash DD slash YYYY
3. Trainee Organization Name
Trainee Organization Name*
4. Trainee's Organization Type
Trainee's Organization Type*
- Information and referral providers, options counselors
- Case managers, care coordinators, discharge planners
- Direct care workers (certified nursing assistants, personal care attendants, companions)
- Health care providers (e.g. physicians, nurse practitioners, nurses)
- Allied health providers (e.g. occupational therapists, pharmacists, dietitians)
- Volunteers (e.g. Meals on Wheels, friendly visitors)
- Other dementia-related program providers (e.g. caregiver skills trainers, support group facilitators, adult day services staff)
- First responders
- Clergy, other members of faith community
- Financial professionals (e.g. bank tellers, financial planners)
- Legal professionals
- Community businesses (banks, retail stores, pharmacies, cafes, etc)
- Students preparing for dementia-related work
- Profession Missing
- Other (please specify)
5. Location of Training
Location of Training*
- In-person
- Remote (e.g. online via Zoom, Skype, GoToMeeting, Webex, etc.; phone; or other remote option)
Here are some statements about dementia.
Please read each statement carefully and choose a response to show if you agree or disagree with the statement, or if you don’t know.
It is important to choose one response (yes, no, or don’t know) for every statement.
6. Respond True, False, or Don't Know to the following items.
Dementia is part of normal aging.*
- True
- False
- Don't Know
Dementia is not just about having memory problems. It can affect thinking, communication and everyday tasks.*
- True
- False
- Don't Know
People with dementia may express themselves or communicate through actions instead of words.*
- True
- False
- Don't Know
Brain changes causing dementia are often progressive.*
- True
- False
- Don't Know
Loud noises do not cause people with dementia to become agitated.*
- True
- False
- Don't Know
It is important to always correct a person who has dementia when they are confused.*
- True
- False
- Don't Know
Only older adults develop dementia.*
- True
- False
- Don't Know
When a person has late stage dementia, families can help others to understand that person’s needs.*
- True
- False
- Don't Know
Movement (e.g., walking, moving in a bed or chair) is limited in late stage dementia*
- True
- False
- Don't Know
It is impossible to tell if a person who is in the later stages of dementia is in pain*
- True
- False
- Don't Know
7. Use the rating scale from Strongly Agree to Strongly Disagree to respond to the following items
I am confident interacting with individuals with dementia.*
- Strongly Agree
- Agree
- Neutral
- Disagree
- Strongly Disagree
People with dementia need to feel respected, just like anyone else.*
- Strongly Agree
- Agree
- Neutral
- Disagree
- Strongly Disagree
I can respond to people with dementia with understanding.*
- Strongly Agree
- Agree
- Neutral
- Disagree
- Strongly Disagree
I am motivated to get to know people with dementia better.*
- Strongly Agree
- Agree
- Neutral
- Disagree
- Strongly Disagree
Did you learn about accessing community resources related to dementia as part of this workshop/training/session?*
- Strongly Agree
- Agree
- Neutral
- Disagree
- Strongly Disagree

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