IAA Summative Evaluation

Individual Activity Summative Evaluation
Following your activity, please analyze your evaluation data and submit the Summative Evaluation within 30 days of the conclusion of your program. If your activity is enduring, we ask that you submit your summative evaluation annually by January 15th of the following year.

The Summative Evaluation should include an analysis of whether the learning outcome measure was met and a reflection on any implications for future programming gained from evaluation of this activity.
Activity Details
VNA Approval #:*
Organization Name:*
Agency/ business website
Point of Contact:*

First NameLast Name
Contact Phone:*
Contact Email: *
example@example.com
Activity Title: *
Activity Date: *

MonthDayYear
Is this activity a repeat activity? *

YesNo
Target Audience (RN, Interprofessional, etc)*
Did you receive commercial support?*

YesNo
Who provided the commercial support?
Please disclose the amount of money provided and/or list the type of in-kind support given.*
Please separate multiple items with a semicolon.
How much commercial support did you receive? (write 0 if none)*
Was this activity jointly provided?*

YesNo
Who was the Joint Provider organization?
Learner Details
Nursing contact hours awarded to each participant:*
If partial credit was given, please indicate so.
Total number of RN participants:*
Total number of non-RN participants:*
Total contact hours awarded (number of contact hours awarded x total number of RNs):*
Comments:
Evaluation Summary*

Cancelof
Evaluation Summary

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Summative Evaluation

Provide a post-activity analysis of individual educational activity data that determines if the educational activity successfully changed the knowledge, skill, and/or practice of the learners.
Please describe whether the activity met the intended learning outcome(s)?*

(Limit 250 words)0/250
Please describe how the assessment data will be used to guide future activities?*

(Limit 250 words)0/250
Evaluation Summary

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Should be Empty:

Individual Activity Summative Evaluation

Activity Details

Learner Details

Summative Evaluation