Westberg Webinars General Evaluation Form

Westberg Webinars General Evaluation Form

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

Month Day Year
Date
Date Completed *
Certificate Information
Email used to register for webinar *
Name for certificate *

First Name Last Name
Choose one or more to describe your practice

RN FCN Chaplain/Clergy Other
If Other, please specify
Credentials
Mailing Address

Street Address

Street Address Line 2

City State / 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: