PARTICIPANT ASSESSMENT FORM

I would like your assessment of the program you attended today. Please fill out this questionnaire as completely, carefully, and candidly as possible. Circle the appropriate answer or fill in the blank.

Name of Program __________________________________________________________________

Today's Date ____________________Facilitator's Name ____________________________________

1. How would you rate the QUALITY of the program you attended today?

1
excellent

2
good

3
fair

4
poor
2. Was the material presented in an ORGANIZED and coherent manner?

1
yes, definitely

2

3

4
no, not at all
3. Did the facilitator(s) stimulate your interest?

1
very interesting

2

3

4
not very interesting
4. How much did you LEARN?

1
a great deal

2

3

4
nothing
5. How USEFUL will the information presented be to you in the future?

1
extremely useful

2

3

4
not at all useful
6. How SUPPORTIVE will you be to this type of presentation in the future?

1
very supportive

2

3

4
of little support

7. The part I liked best about today's program was

__________________________________________________________________________________________

8. The part I liked least about today's program was

________________________________________________________________________

9. Suggestions for enhancing this particular program are

_________________________________________________________________________