Evaluation Form
FULL NAME (OPTIONAL)
First Name
Last Name
NAME OF INSTRUCTOR
*
Please Select
Ken Cooper
Scott Dixon
Lisa Rigsby
Sarah Austin
WHICH SEMINAR?
*
LEVEL 1
LEVEL 2
PELVIC
LAST DAY OF SEMINAR
*
-
Month
-
Day
Year
Date
LOCATION OF SEMINAR
*
YOUR OVERALL SATISFACTION WITH THE COURSE (1 POOR, 5 EXCELLENT)?
*
5
4
3
2
1
CURRENT LEVEL OF CONFIDENCE YOU NOW HAVE OF DRY NEEDLING (1 POOR, 5 EXCELLENT)?
*
5
4
3
2
1
ABILITY YOU HAVE TO BEGIN INTRODUCING NEEDLING MONDAY (1 POOR, 5 EXCELLENT)?
*
5
4
3
2
1
CONFIDENCE IN RECOMMENDING THIS COURSE TO OTHERS (1 POOR, 5 EXCELLENT)?
*
5
4
3
2
1
THE INFORMATION RECEIVED WAS USEFUL AND BENEFICIAL
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM MET THE STATED LEARNING OBJECTIVES
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PRESENTATION STYLE ENHANCED MY LEARNING EXPERIENCE
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY WAS RESPONSIVE TO QUESTIONS/COMMENTS
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE EDUCATIONAL MATERIALS WERE USEFUL?
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE LEARNING ASSESSMENT (TEST) WAS APPROPRIATE
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
WHAT DID YO LIKE MOST ABOUT THIS PROGRAM?
*
WHAT DID YO LIKE LEAST ABOUT THIS PROGRAM?
*
DO YOU FEEL THERE WAS COMMERCIAL BIASE OR INFLUENCE IN THIS ACTIVITY?
*
YES
NO
IF YES, PLEASE EXPLAIN
PLEASE RATE THE FOLLOWING COMPONENTS OF THIS PROGRAM
REGISTRATION PROCESS
*
EXCELLENT
GOOD
FAIR
POOR
PROGRAM FACULTY
*
EXCELLENT
GOOD
FAIR
POOR
LOCATION
*
EXCELLENT
GOOD
FAIR
POOR
WAS THE PROGRAM FACULTY KNOWLEDGEABLE REGARDING THE CONTENT OF THEIR PRESENTATION
*
YES
NO
WAS THE PROGRAM FACULTY RELEVANT REGARDING THE CONTENT OF THEIR PRESENTATION
*
YES
NO
WAS THE PROGRAM FACULTY EFFECTIVE WITH THE CONTENT OF THEIR PRESENTATION
*
YES
NO
IF YOU ANSWERED NO TO ANY OF THE 3 QUESTIONS ABOVE PLEASE EXPLAIN
THE PRESENTATION MET MY EXPECTATIONS
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY STYLE WAS APPROPRIATE FOR THE MATERIAL PRESENTED
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY WAS RESPONSIVE TO QUESTIONS/COMMENTS
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM MET MY OBJECTIVES
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE INFORMATION RECEIVED WAS USEFUL AND BENEFICIAL
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
GENERAL COMMENTS
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