The Institute of Medical Education (IME) is conducting a study to determine if there is sufficient interest in the development of a part time evening dental hygiene program. Lecture courses will be conducted in the evening at the Oakland campus and all clinical and laboratory sessions will be held in the evenings at the San Jose facility. We would appreciate your response to the following questions. If we obtain a favorable response the development of the part time evening dental hygiene program may start as soon as the Fall 2011. Thank you for your time. If you wish to submit the survey via mail,please send your surveyto:Carla@imededu.com.

1. What is your current relationship to IME? 2. Assuming that a part time evening dental hygiene program is available at a convent time, how likely is it that you would enroll in the program? For those who select “Will not enroll” Please skip to question 3. How important would the IME dental hygiene program be for you in terms of the following benefits listed below? (Please rate with 5 being most important and 1 being least important) 4. Would you be willing to attend evening classes from Monday-Friday? 5. What is your highest level of education? 6. If a part time evening dental hygiene program is available who soon would you consider enrolling in the program?

CONTACTS
Full name:		Contact #*
Street Address*		Email*
Thank you for your time. Please complete sooner, and send your survey to: Carla Loiacono, RDH,MS Institute of Medical Education 130 Park Center Plaza San Jose, CA 95113.