Personal Information

1. Gender (optional)  Male  Female 2. Age (optional) 3. State in which you work 4. What is your highest level of education?  HS  AA  BA/S  MA/S  PhD  Other Are you currently attending school?  Yes  No 5. Please list all certifications/licenses you hold 6. How long have you been working with individuals with brain injury? 7. What is your current job title?

Employment History

8. Number of jobs held in the year before attaining CBIS 9. Please, briefly describe the types of jobs you held 10. Number of jobs held in the year after attaining CBIS 11. Please, briefly describe the types of jobs you held 12. How long have you held your CBIS? Certification date of CBIS How long have you been a Certified Brain Injury Specialist Trainer (CBIST)? Certification date of CBIST 13. Did you receive a pay raise as a result of attaining your CBIST?  Yes  No If yes, was the pay raise significant to you?  Yes  No 14. Do you plan to continue working with this population?  Yes  No 15. In your opinion, has your CBIS resulted in better client care/outcomes?  Yes  No 16. As a result of achieving your CBIS, are you interested in furthering your education?  Yes  No 17. Would you consider getting an advanced level CBIS?  Yes  No If yes, for what purpose?  professional growth  increased salary/wages  increase in general knowledge of brain injury  other 18. Has earning a CBIS contributed to your professional growth?  Yes  No If yes, have you referenced your CBIS?  Yes  No If yes, for what purpose? Please check all that apply.  employment applications  professional material/presentations  college applications  other 19. Will you renew your certification?  Yes  No If no, why? Please check one.  too expensive  too much work  left the field of brain injury and/or social services  had little effect on my professional growth  new job, CBIS not supported  other If yes, when? Please rate the following on a scale of 1-10. 1=too easy . . . 10=too hard. The certification process 1 2 3 4 5 6 7 8 9 10 The information quality of the CBIS manual 1 2 3 4 5 6 7 8 9 10 The ease of reading of the CBIS manual 1 2 3 4 5 6 7 8 9 10 The CBIS examination 1 2 3 4 5 6 7 8 9 10 Does the CBIS study guide approximate your job duties? 1=not at all . . . 10=very much. 1 2 3 4 5 6 7 8 9 10 Please provide additional feedback and suggestions regarding the certification process

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