Workshop Evaluation Form - Hepatitis C

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Workshop Evaluation Form
Name of Event:
Date:
/
/
Type of Event:
Male
 Under 13
 Black 
Are you:
Home Zip Code:
Female
 13-19  20-29
Latino/a
Transgender
 30-49  50 +
 White  Asian
Other
 PI
 Other
 Private
 Medicaid
Medicare
Do you have insurance? (check one) :
Please take a few minutes to tell us about your experience in this session. Your feedback will greatly assist us in
future planning. Thank you for your cooperation. Please circle your answer.
Knowledge of Topic Area
No
Beginner
Intermediate Advanced
Knowledge
1. What is your level of knowledge in this topic area before this session?
1
2
3
4
2. How would you rate your knowledge in this topic after completing this
1
2
3
4
session?
Practice or Use of the Information and Materials
No Skill
Slightly
Moderately
Very
Skilled
Skilled
Skilled
3. How would you rate your skill level in the topic area before this session?
1
2
3
4
4. How would you rate your skill level in the topic are completing this
1
2
3
4
session?
Never
Infrequently
Sometimes
Often
5. How often do you anticipate using this information and materials
1
2
3
4
presented in your work?
Overall Attitudes and Satisfaction
Poor
Fair
Good
Excellent
6. What is the overall usefulness of the information and materials
1
2
3
4
presented in this session?
7. How well do you think the information and materials presented apply to
1
2
3
4
African Americans?
8. How well did the information and materials presented in this session
1
2
3
4
meet your professional needs?
9. How well did this session meet your expectations in terms of topics
1
2
3
4
covered?
10. How would you rate the expertise of the trainer or presenter for this
1
2
3
4
session?
11. How would you rate the presentation by the trainer or presenter?
1
2
3
4
12. How would you rate the presentation format used in this session?
1
2
3
4
13. How would you rate the quality of the information and materials
1
2
3
4
presented in this session?
14. How did you learn about this session? (eg: flyer, newspaper word-of-mouth )______________________
15. Do you have any additional comments?
____________________________________________________________________________________
____________________________________________________________________________________
Thank you again for your time and cooperation.
Workshop Evaluation Form
Name of Event:
Date:
/
/
Type of Event:
Male
 Under 13
 Black 
Are you:
Home Zip Code:
Female
 13-19  20-29
Latino/a
Transgender
 30-49  50 +
 White  Asian
Other
 PI
 Other
 Private
 Medicaid
Medicare
Do you have insurance? (check one) :
Please take a few minutes to tell us about your experience in this session. Your feedback will greatly assist us in
future planning. Thank you for your cooperation. Please circle your answer.
Knowledge of Topic Area
No
Beginner
Intermediate Advanced
Knowledge
1. What is your level of knowledge in this topic area before this session?
1
2
3
4
2. How would you rate your knowledge in this topic after completing this
1
2
3
4
session?
Practice or Use of the Information and Materials
No Skill
Slightly
Moderately
Very
Skilled
Skilled
Skilled
3. How would you rate your skill level in the topic area before this session?
1
2
3
4
4. How would you rate your skill level in the topic are completing this
1
2
3
4
session?
Never
Infrequently
Sometimes
Often
5. How often do you anticipate using this information and materials
1
2
3
4
presented in your work?
Overall Attitudes and Satisfaction
Poor
Fair
Good
Excellent
6. What is the overall usefulness of the information and materials
1
2
3
4
presented in this session?
7. How well do you think the information and materials presented apply to
1
2
3
4
African Americans?
8. How well did the information and materials presented in this session
1
2
3
4
meet your professional needs?
9. How well did this session meet your expectations in terms of topics
1
2
3
4
covered?
10. How would you rate the expertise of the trainer or presenter for this
1
2
3
4
session?
11. How would you rate the presentation by the trainer or presenter?
1
2
3
4
12. How would you rate the presentation format used in this session?
1
2
3
4
13. How would you rate the quality of the information and materials
1
2
3
4
presented in this session?
14. How did you learn about this session? (eg: flyer, newspaper word-of-mouth )______________________
15. Do you have any additional comments?
____________________________________________________________________________________
____________________________________________________________________________________
Thank you again for your time and cooperation.

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