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Workshop Evaluation
Workshop Topic:
Date:
MM slash DD slash YYYY
Location:
Speaker Name:
Please circle the number that matches how you feel about this workshop:
1. The information I received today was easy to understand.
A lot!
Some
A little
Not at all
2. I feel prepared to use the information I received today.
A lot!
Some
A little
Not at all
3. The information I received today met my needs.
A lot!
Some
A little
Not at all
4. I feel comfortable in my ability to work with my child’s school and/or health team.
A lot!
Some
A little
Not at all
5. I am likely to attend another Parents’ Place workshop.
A lot!
Some
A little
Not at all
Rate your understanding of the topic before and after the workshop:
My understanding of the topic before the workshop:
A lot!
Some
A little
Not at all
My understanding of the topic after the workshop:
A lot!
Some
A little
Not at all
Comments:
Describe yourself: (check one)
Parent
Other relative
Student
Professional
My Child’s Race:
African American/Black
Asian
American Indian/Alaska Native
Hawaiian/Pacific Islander
White/Caucasian
Two or more races
My Child’s Ethnicity
Hispanic/Latino
Non-Hispanic/Latino
My Child’s Disability:
Autism
ADD/ADHD
Deaf/Blind
Developmental Delay
Intellectual Disability
Deaf/Hearing Impairment
Emotional Disability
Learning Disability
Multiple Disabilities
Other Health Impairment
Orthopedic Impairment
Speech & Language
Traumatic Brain Injury
Vision Impairment/Blind
Suspected Disability
None
My Child’s Age:
Birth up to age 3
Ages 3 through 5
Ages 6 through 11
Ages 12 through 14
Ages 15 through graduation or age out
Beyond high school graduation (or aged out)
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Campaign Id
*
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Contact Id
*