1 Start 2 Complete

Did the presenter appear unbiased and free from commercial interest during the session? *

Yes

No

Unsure

To what extent were the learning objectives of this session met? *

Not at all met

Partially met

Completely met

On a scale of 1 to 5, how confident are you that you will be able to apply information from this Training & Technical Assistance activity at your health center/organization? *

1 - Not at all confident

2 - Somewhat confident

3 - Moderately confident

4 - Very confident

5 - Extremely confident

What did you like most about this session?

What would you change to improve future sessions?

Please rate the quality of the following from this session. *

	Low Quality	Average Quality	High Quality	N/A
The content included in the presentation	The content included in the presentation - Low Quality	The content included in the presentation - Average Quality	The content included in the presentation - High Quality	The content included in the presentation - N/A
The supplemental resources provided during the presentation	The supplemental resources provided during the presentation - Low Quality	The supplemental resources provided during the presentation - Average Quality	The supplemental resources provided during the presentation - High Quality	The supplemental resources provided during the presentation - N/A
The presentation of the content by the faculty member	The presentation of the content by the faculty member - Low Quality	The presentation of the content by the faculty member - Average Quality	The presentation of the content by the faculty member - High Quality	The presentation of the content by the faculty member - N/A
The overall facilitation of the session	The overall facilitation of the session - Low Quality	The overall facilitation of the session - Average Quality	The overall facilitation of the session - High Quality	The overall facilitation of the session - N/A

How would you rate this session on the following? *

	Too Few	Just Right	Too Many	N/A
Opportunities to engage in discussion	Opportunities to engage in discussion - Too Few	Opportunities to engage in discussion - Just Right	Opportunities to engage in discussion - Too Many	Opportunities to engage in discussion - N/A
Opportunities to ask questions	Opportunities to ask questions - Too Few	Opportunities to ask questions - Just Right	Opportunities to ask questions - Too Many	Opportunities to ask questions - N/A

Please indicate the extent to which you agree with the following statements: *

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I gained new knowledge as a result of attending this session.	I gained new knowledge as a result of attending this session. - Strongly Disagree	I gained new knowledge as a result of attending this session. - Disagree	I gained new knowledge as a result of attending this session. - Agree	I gained new knowledge as a result of attending this session. - Strongly Agree	I gained new knowledge as a result of attending this session. - N/A
I learned new skills as a result of attending this session.	I learned new skills as a result of attending this session. - Strongly Disagree	I learned new skills as a result of attending this session. - Disagree	I learned new skills as a result of attending this session. - Agree	I learned new skills as a result of attending this session. - Strongly Agree	I learned new skills as a result of attending this session. - N/A
I am confident in my ability to use what I learned from this session in my practice.	I am confident in my ability to use what I learned from this session in my practice. - Strongly Disagree	I am confident in my ability to use what I learned from this session in my practice. - Disagree	I am confident in my ability to use what I learned from this session in my practice. - Agree	I am confident in my ability to use what I learned from this session in my practice. - Strongly Agree	I am confident in my ability to use what I learned from this session in my practice. - N/A

Please indicate the extent to which you agree with the following statements: *

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
The information presented motivates me to change aspects of my current practice or treatments habits.	The information presented motivates me to change aspects of my current practice or treatments habits. - Strongly Disagree	The information presented motivates me to change aspects of my current practice or treatments habits. - Disagree	The information presented motivates me to change aspects of my current practice or treatments habits. - Agree	The information presented motivates me to change aspects of my current practice or treatments habits. - Strongly Agree	The information presented motivates me to change aspects of my current practice or treatments habits. - N/A
The information presented motivates me to enhance my team-based practices.	The information presented motivates me to enhance my team-based practices. - Strongly Disagree	The information presented motivates me to enhance my team-based practices. - Disagree	The information presented motivates me to enhance my team-based practices. - Agree	The information presented motivates me to enhance my team-based practices. - Strongly Agree	The information presented motivates me to enhance my team-based practices. - N/A
I see a connection between this information and how I care for my patients.	I see a connection between this information and how I care for my patients. - Strongly Disagree	I see a connection between this information and how I care for my patients. - Disagree	I see a connection between this information and how I care for my patients. - Agree	I see a connection between this information and how I care for my patients. - Strongly Agree	I see a connection between this information and how I care for my patients. - N/A

Please indicate the extent to which you agree with the following statements: *

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
The information presented addressed a professional practice gap	The information presented addressed a professional practice gap - Strongly Disagree	The information presented addressed a professional practice gap - Disagree	The information presented addressed a professional practice gap - Agree	The information presented addressed a professional practice gap - Strongly Agree	The information presented addressed a professional practice gap - N/A
The information that was shared is relevant to my practice setting	The information that was shared is relevant to my practice setting - Strongly Disagree	The information that was shared is relevant to my practice setting - Disagree	The information that was shared is relevant to my practice setting - Agree	The information that was shared is relevant to my practice setting - Strongly Agree	The information that was shared is relevant to my practice setting - N/A
The information presented validated my current practice or treatment habits	The information presented validated my current practice or treatment habits - Strongly Disagree	The information presented validated my current practice or treatment habits - Disagree	The information presented validated my current practice or treatment habits - Agree	The information presented validated my current practice or treatment habits - Strongly Agree	The information presented validated my current practice or treatment habits - N/A
If I apply this information in my practice setting, patient outcomes will improve	If I apply this information in my practice setting, patient outcomes will improve - Strongly Disagree	If I apply this information in my practice setting, patient outcomes will improve - Disagree	If I apply this information in my practice setting, patient outcomes will improve - Agree	If I apply this information in my practice setting, patient outcomes will improve - Strongly Agree	If I apply this information in my practice setting, patient outcomes will improve - N/A

Please list any practice changes you plan on making as a result of what you learned from this session. If you do not plan on making any changes, please write "no changes". *

At the Weitzman Institute, we value inclusiveness, diversity, and mutually respectful dialogue, and we want to ensure that all feel welcome. If there was anything said in our program that made you feel uncomfortable, please let us know here.

Please use this space to list new ideas you have for future session topics or share additional comments.

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