Application of Surveillance Principles to Food Safety
University of Minnesota University of Minnesota
School of Public Health

Application of Surveillance Principles to Food Safety

Participant Information Form

Please complete the following information. No identifying information will be included when compiling reports associated with this data.


What is your job position or role?
If you selected other job position, please specify:

What type of organization you work for?








If you chose other organization, please describe:
What is your race/ethnicity?









If you chose other race/ethnicity, please specify:

Gender


What state do you live in?
If you live in Minnesota, please select county:
If you selected a state other than Minnesota, please enter your county:

After completing this form, please select the "Submit" button:

(Select Only Once)
©2004 Regents of the University of Minnesota. All rights reserved. Last modified:12/7/2004