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Health Assessment

You are entitled to participate in an online survey. The details of the survey are:
COAHOMA COMMUNITY COLLEGE
CCC Fit for Life Healthy Campus Initiative
Fall 2017
Health Assessment
http://cccsurveys.coahomacc.edu/classclimate/online.php?pswd=W6MSJ
 
Thank you for participating in the Coahoma Community College Fit for Life Healthy Campus Initiative Health Assessment.  Please take a few minutes to complete this assessment.  Your responses are confidential and will be kept in your file for the Fit for Life staff members to review.

1Personal Information

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2Pretesting Data:  Must be completed by Test Administrator

3Health Risk Assessment:  To provide you with the best service possible, it is important for us to review issues that might impact your health.  This form is confidential and will be kept in your file for CCC Fit for Life Healthy Campus Initiative staff members to review.

 
 

4Emergency Contact Information: Please provide the name, phone number, and relationship of at least two people we may contact in case of an emergency.

 
 

THANK YOU!