PROGRAM EVALUATION FORM

NAME OF PROGRAM SPONSOR:

DATE OF PROGRAM:

LOCATION OF PROGRAM:

NAME(S) OF FACILITATOR(S):

DESCRIPTION OF AUDIENCE:

Please answer this evaluation form by circling the number you feel is most appropriate. #1 is low, #5 is high.

               1.        Did this program meet your expectations?                                     1 2 3 4 5

2.       How would you judge the quality of the

presentation?                                                                                      1 2 3 4 5

               3.        Was the topic relevant to you?                                                         1 2 3 4 5

4.       Did you come away with tools/ideas which

                          you did not have prior to this program?                                          1 2 3 4 5

               5.        Did the program hold your interest?                                                1 2 3 4 5

6.       Would you recommend this program be

                          presented to other groups?                                                              1 2 3 4 5

Other comments/suggestions:

I would like to be notified about additional parent education/support group programs.

Name_________________________________

Address_______________________________

Phone_________________________________

Email _________________________________

THANK YOU FOR YOUR HELP.