Trauma and Toxic Stress Presentation Feedback Form - Michigan

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Feedback Form
We would like your feedback about this presentation on the impact of trauma and toxic stress. Please answer
the following questions honestly and to the best of your ability. Your feedback is greatly appreciated!
Date of Training: ______________ Location: _________________ Trainer: ________________
Please circle the response below that best describes your agreement with the item from “Strongly Disagree”
to “Strongly Agree”:
Strongly
Strongly
Disagree
Agree
Disagree
Agree
1. The presentation was easy to follow.
1
2
3
4
2. The presentation materials were clear.
1
2
3
4
3. The trainer(s) was/were prepared.
1
2
3
4
4. The trainer(s) was/were knowledgeable about the
1
2
3
4
topic.
5. I was very satisfied with the amount of information in
1
2
3
4
the presentation.
6. The information presented was clear and easy to
1
2
3
4
understand..
7. I can apply what I learned at the presentation in my
1
2
3
4
work.
8. I can apply what I learned at the presentation in my
1
2
3
4
personal life.
9. As a result of attending this presentation, I will be
1
2
3
4
more effective in my job or as a parent.
What were the most useful things that you learned from this training?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What were the least useful things that you learned from this training?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What questions do you still have about the impact of trauma and toxic stress?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(continued on back)
Feedback Form
We would like your feedback about this presentation on the impact of trauma and toxic stress. Please answer
the following questions honestly and to the best of your ability. Your feedback is greatly appreciated!
Date of Training: ______________ Location: _________________ Trainer: ________________
Please circle the response below that best describes your agreement with the item from “Strongly Disagree”
to “Strongly Agree”:
Strongly
Strongly
Disagree
Agree
Disagree
Agree
1. The presentation was easy to follow.
1
2
3
4
2. The presentation materials were clear.
1
2
3
4
3. The trainer(s) was/were prepared.
1
2
3
4
4. The trainer(s) was/were knowledgeable about the
1
2
3
4
topic.
5. I was very satisfied with the amount of information in
1
2
3
4
the presentation.
6. The information presented was clear and easy to
1
2
3
4
understand..
7. I can apply what I learned at the presentation in my
1
2
3
4
work.
8. I can apply what I learned at the presentation in my
1
2
3
4
personal life.
9. As a result of attending this presentation, I will be
1
2
3
4
more effective in my job or as a parent.
What were the most useful things that you learned from this training?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What were the least useful things that you learned from this training?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What questions do you still have about the impact of trauma and toxic stress?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(continued on back)
What improvements would you suggest for future trainings?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please circle the primary role you have with young children below:
Home Visitor
Child Care Provider
Health Care Provider
Child Welfare Provider
Early Childhood Educator
Parent/Caregiver
Other, please specify: ___________
What is your work setting? Circle the most appropriate:
Home visiting program
Primary care office/clinic
Hospital
Child care center
Family day care home
Preschool/Head Start program
Child welfare agency
Early Intervention program
Other, please specify: _____________
What county do you live in? _____________________________
What county do you work in? ____________________________
Thank you for taking the time to provide feedback about this presentation!
Please complete this form and return it to Mary Mueller at:
MuellerM1@michigan.gov
OR
MDCH-Division of Family & Community Health
th
Washington Square Bldg. 4
Floor
PO Box 30195
Lansing, MI 48913-1557

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