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Program Sponsor/School
Program Title
Program Number
Clock Hours
Participant Name
Program Date
MM/DD/YYYY
Location
Instructor
Please Record Responses in Each Rating Category: Strongly Disagree <-> Strongly Agree
COURSE MATERIAL:
Course objectives were clear 12345
Course objectives were met 12345
Course material was well organized 12345
Course material was presented in sufficient depth 12345
Overall, the course is personally and/or professionally beneficial 12345
I would recommend this program to my colleagues 12345
COMPLETE IF LIVE/CLASSROOM SETTING:
The instructor was knowledgeable in the subject 12345
The teaching methods used by the instructor were effective 12345
Instructor communicated subject matter well 12345
Instructor supervised course well 12345
COMPLETE ONLY IF DISTANCE LEARNING PROGRAM
The course website was easy to navigate 12345
Instructions for using course materials were clear 12345
Technical support was readily available 12345
Please describe any changes you recommend to improve this program:
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Honorable John Jenkins / P.O. Box 7205, Lewiston, Maine 04243-7205
e-mail: peptalk@peptalk.com / 1-888-PEPTALK (737-8255) / 207-783-3413

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