Form 1 Host Survey

National Library of Medicine Traveling Exhibition Host Survey

OMB Control Number: 0925-0648
Expiration Date: 03/2018
Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.
Thank you for hosting a traveling exhibition from the Exhibition Program at the National Library of Medicine (NLM). We value your
partnership and ask for feedback on your experiences so that we may better serve you in the future. Do not return the completed form
to this address.

* 1. Please provide the following information.
Host Institution Name
Traveling Exhibition Title
Display Dates (mm/dd/yymm/dd/yy)
Display Location (address)

* 2. Please provide the number of visitors to the exhibition based on one of the two counting methods below:

Actual visitor count
Estimated visitor count
(20% of institution visitors)

* 3. Who were your visitors to the exhibition? Please check all that apply.
College and university faculty and students
K-12 teachers and students
General public
Allied health professionals
Other (please specify)

* 4. Did the exhibition help you bring new or first-time visitors to your institution?
No
I don't know
Yes, please describe the new or first time visitors.

* 5. Did your institution create a local display of items in conjunction with the traveling exhibition?
No
Yes, please provide a brief description of the items on display.

6. Please provide a few details about each program you created in conjunction with the traveling exhibition.
If no programming, please go to question 7.
1. Program title
# of attendees
Any online NLM resources
used in the event
2. Program title
# of attendees
Any online NLM resources
used in the event
3. Program title
# of attendees
Any online NLM resources
used in the event
4. Program title
# of attendees
Any online NLM resources
used in the event
5. Program title
# of attendees
Any online NLM resources
used in the event

7. Please tell us about how your community or visitors responded to the traveling exhibition from the
National Library of Medicine.

8. Please tell us how Traveling Exhibition Services at the National Library of Medicine can better support
your efforts to reach and meet the needs of your community members.