Westberg Webinars General Evaluation Form

Westberg Webinars General Evaluation Form

revised 1/22
Course Information
Webinar Name*
Contact Hours
Webinar Name*
Date*

MonthDayYear
Date
Date Completed*
Certificate Information
Email used to register for webinar*
Name for certificate*

First NameLast Name
Choose one or more to describe your practice

RNFCNChaplain/ClergyOther
If Other, please specify
Credentials
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course and Instructor Evaluation

Please evaluate*

	Excellent	Good	Fair
The course as a whole was:
The course content will impact/change my practice in some way:
The webinar increased my knowledge of the topic:
The webinar met my expectations:

other topics I would like to attend
Comments
Should be Empty: