Sample Participant Evaluation Form

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{ADD Meeting Title here}
Jointly Sponsored by AANS
{ADD Meeting Dates here}
Sample Participant Evaluation Form
Rating Scale (Circle the appropriate letter)
1=Poor
2=Fair
3=Good
4= Very Good
5= Excellent
LEARNING OBJECTIVES
How well were the following objectives met?
1. Objective 1
1
2
3
4
5
(Please write out each objective)
2. Objective 2
1
2
3
4
5
Comments:
PROGRAM
4. Topics addressed completely
1
2
3
4
5
5. Content relevant to my practice
1
2
3
4
5
6. Opportunities for questions/discussion
1
2
3
4
5
7. What did you like most about this meeting? ________________________________
8. What changes do you intend to make in your practice as a result of the meeting?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. How could this meeting be improved?
_____________________________________________________________________
_____________________________________________________________________
10. Did you perceive any commercial bias during this program? ____Yes
____No
If yes, please explain what was perceived as promotional and not educational,
(Please include the presentation title and presenter):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
11. What topics for future programs or information would be of greatest interest to
you?
____________________________________________________________________
____________________________________________________________________

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