COPE Post-Activity Evaluation Form CE credits will be submitted within 30 days of submission. Please complete the ARBO required survey below to secure your credits. COPE Post-Activity Educational Evaluation Please complete this form to secure COPE Credits. Today's Date(Required) MM slash DD slash YYYY Doctor's Name(Required) First Last Email Address(Required) OE Tracker Number(Required) License Information(Required) License Number AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Event Name(Required)Please select from the options in the dropdown below.Chocolate Tasting EventRed Shoes EventAnnual Educational RetreatThink Pink EventWinter Wonderland EventVirtual MeetingEvent Date(Required) MM slash DD slash YYYY Event/Chapter LocationPlease enter the event city and state below. If the event was virtual, skip this question. City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State As a result of this CE activity, I have developed new strategies to address the issues that were discussed.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, my ability and skills have been improved.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I have identified changes I will implement in my practice.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I will significantly change the way I will treat and care for my patients.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I expect positive changes in my patient outcomes.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree Comments