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									                                                           Sample Participant Evaluation Form
                                                                           A-TrACC Field Guide Suggestions
                                                                CE/PES Continuing Education/Professional Education and Support
1
 Information for this form is provided voluntarily. AHEC is required to report information about program participants. Data will be kept private to the extent allowed by law and will be referenced
periodically to evaluate the effectiveness of AHEC services and programs. We appreciate your cooperation in the completion of this form. Please type or print clearly.

2
    Today’s Date:                    3   CE Offering Title:
4   1. In this educational session I increased my knowledge of _____________.
              Strongly Agree      Agree         Somewhat Agree      Disagree                                                   Strongly Disagree                  Not Applicable
                1____                 2____          3____             4____                                                          5 ____                           ____

5   2. After completing this CE I improved skill in ______________________________________.
              Strongly Agree       Agree         Somewhat Agree     Disagree    Strongly Disagree                                                                 Not Applicable
                1____                2____             3____           4____           5 ____                                                                          ____


6   3. After completing this educational session I intend to improve : ________________________________________________

7   4. I will ____________________________________________________________________________.
              Strongly Agree   Agree       Somewhat Agree    Disagree    Strongly Disagree  Not Applicable
                1____             2____         3____           4____           5 ____        ____

8   5. Before completing this educational session, I ____________________________________________________.
             Strongly Agree      Agree         Somewhat Agree      Disagree    Strongly Disagree  Not Applicable
               1____               2____              3____           4____           5 ____        ____



      *Blue numbers correspond with Guidelines items.




                                                                     1                                                  A-TrACC Field Guide Suggestions Participant Evaluation Form 02/22/12

								
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