OT EVAL

1. The following disclosure was provided prior to beginning this course: *

	1 Yes	2 No
a Acknowledgement of any conflict of interest.	a Acknowledgement of any conflict of interest. - 1 Yes	a Acknowledgement of any conflict of interest. - 2 No
b Acknowledgement of any financial relationships.	b Acknowledgement of any financial relationships. - 1 Yes	b Acknowledgement of any financial relationships. - 2 No
c Criteria for successful completion of course.	c Criteria for successful completion of course. - 1 Yes	c Criteria for successful completion of course. - 2 No

2. Were the learning methods appropriate? *

Yes

No

3. Did you learn what you expected to learn? *

Yes

No

4. Were the learning materials helpful? *

Yes

No

5. As a result of the course NAME OF COURSE HERE, I am able to : *

	5 Strongly Agree	4 Agree	3 Neutral	2 Disagree	1 Strongly Disagree
a. LIST OBJECTIVES FOR COURSE HERE	a. LIST OBJECTIVES FOR COURSE HERE - 5 Strongly Agree	a. LIST OBJECTIVES FOR COURSE HERE - 4 Agree	a. LIST OBJECTIVES FOR COURSE HERE - 3 Neutral	a. LIST OBJECTIVES FOR COURSE HERE - 2 Disagree	a. LIST OBJECTIVES FOR COURSE HERE - 1 Strongly Disagree
b.	b. - 5 Strongly Agree	b. - 4 Agree	b. - 3 Neutral	b. - 2 Disagree	b. - 1 Strongly Disagree
c.	c. - 5 Strongly Agree	c. - 4 Agree	c. - 3 Neutral	c. - 2 Disagree	c. - 1 Strongly Disagree
d	d - 5 Strongly Agree	d - 4 Agree	d - 3 Neutral	d - 2 Disagree	d - 1 Strongly Disagree

6. The presenter or author was effective in communicating relevant information : *

	5 Strongly Agree	4 Agree	3 Neutral	2 Disagree	1 Strongly Disagree
a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE	a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE - 5 Strongly Agree	a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE - 4 Agree	a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE - 3 Neutral	a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE - 2 Disagree	a. PRESENTER FIRST NAME LAST NAME AND CREDENTIALS HERE - 1 Strongly Disagree
b. FLORENCE NIGHTINGALE, MSN, RN	b. FLORENCE NIGHTINGALE, MSN, RN - 5 Strongly Agree	b. FLORENCE NIGHTINGALE, MSN, RN - 4 Agree	b. FLORENCE NIGHTINGALE, MSN, RN - 3 Neutral	b. FLORENCE NIGHTINGALE, MSN, RN - 2 Disagree	b. FLORENCE NIGHTINGALE, MSN, RN - 1 Strongly Disagree

7. Please rate your overall learning experience with the course NAME OF COURSE: *

	5 Strongly Agree	4 Agree	3 Neutral	2 Disagree	1 Strongly Disagree
a. I will be able to apply the knowledge learned in my practice setting	a. I will be able to apply the knowledge learned in my practice setting - 5 Strongly Agree	a. I will be able to apply the knowledge learned in my practice setting - 4 Agree	a. I will be able to apply the knowledge learned in my practice setting - 3 Neutral	a. I will be able to apply the knowledge learned in my practice setting - 2 Disagree	a. I will be able to apply the knowledge learned in my practice setting - 1 Strongly Disagree
b. My clinical practice and/or skills were enhanced	b. My clinical practice and/or skills were enhanced - 5 Strongly Agree	b. My clinical practice and/or skills were enhanced - 4 Agree	b. My clinical practice and/or skills were enhanced - 3 Neutral	b. My clinical practice and/or skills were enhanced - 2 Disagree	b. My clinical practice and/or skills were enhanced - 1 Strongly Disagree

8. List 1-2 things you will change since participating in this educational activity. *

Type Here

10. What other educational topics would you like to see offered in future courses?

Type suggestions here

11. Comments

By checking this box I attest that I completed all components of this course and that I completed this evaluation. *

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