ࡱ> =?<{ bjbjzz 4* RRRRRffffDfz$;R;RRP RR3i.f0R(;; : SAMPLE EVALUATION FORM #1 Topic Title: _________________________________________________________ Participant's Name (optional): _______________________________________ EVALUATION TOOL We appreciate your help in evaluating this program. Please indicate your rating of the presentation in the categories below by circling the appropriate number, using a scale of 1 (low) through 5 (high). Please fill out both sides of this form: OBJECTIVES This program met the stated objectives of: 1. Identify three types of neurological complications often found after traumatic brain injury. 2. Identify three types of other traumatic complications often found after traumatic brain injury. 3. List two types of medications to be avoided after traumatic brain injury. SPEAKERS (generally) 1. Knowledgeable in content areas 2. Content consistent with objectives 3. Clarified content in response to questions CONTENT 1. Appropriate for intended audience 2. Consistent with stated objectives TEACHING METHODS 1. Visual aids, handouts, and oral presentations clarified content 2. Teaching methods were appropriate for subject matter 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5  FACULTYKnowledgeable in Content areaContent consistent with objectivesClarified content in response to questions Dr. Smith 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5COMMENTS: RELEVANCY 1. Information could be applied to practice 2. Information could contribute to achieving personal, professional goals  1 2 3 4 5 1 2 3 4 5  FACILITY 1. Was adequate and appropriate for session 2. Was comfortable and provided adequate space  1 2 3 4 5 1 2 3 4 5  This program enhanced my professional expertise.____ Substantially____ Somewhat____ Not at all I would recommend this program to others.____ Yes____ No____ Not sureCOMMENTS/PROGRAM IMPROVEMENTS: I would like (name of APA-approved sponsor) to provide seminars or workshops on the following topics: IN GENERAL Do you prefer: ____half-day seminars ____full-day seminars ___multi-day seminars Do you prefer seminars in: ____hotels ____hospital ____no preference How much time do you need to respond to a program announcement? ____less than 1 month ____4 to 6 weeks ____more than 6 weeks How did you learn about this program? ____brochure ____supervisor ____colleague ____other How far did you travel to attend this program? ____0-25 miles ____25-50 miles ____50-100 miles ____over 100 miles If you would like to comment in person, please feel free to call the Office of Education at [phone number]. 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