GSCCC Adult Learning Course Evaluation
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1. Course Information
25%
Please enter information about the course that you will be completing this survey on.
1
. Please fill in the below demographic questions:
Please fill in the below demographic questions:
Name:
Troop # or SU Number:
Address:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
*
2
. Which course are you completing this survey for?
Which course are you completing this survey for?
Face to Face Introduction Meeting
Volunteer Essentials
Grade Level Toolkit - Daisy
Grade Level Toolkit - Brownie
Grade Level Toolkit - Junior
Grade Level Toolkit - Cadette
Grade Level Toolkit - Senior
Grade Level Toolkit - Ambassador
Journey Toolkit
Stepping Out
Beginning Troop Camping
Backpacking
Trips and Travel
CPR/ First Aid
Leaderama
Other (please specify)
3
. Please enter date of the course you completed. If you completed an online module, home-study, or tool-kit, please enter the date you completed reviewing the materials.
MM
DD
YYYY
Date:
Please enter date of the course you completed. If you completed an online module, home-study, or tool-kit, please enter the date you completed reviewing the materials. Date: Month
/
Day
/
Year
4
. Please enter the location where you completed the adult learning course:
Please enter the location where you completed the adult learning course:
*
5
. Name of instructor (If Online Module, Home-Study, or Tool-kit please put N/A):
Name of instructor (If Online Module, Home-Study, or Tool-kit please put N/A):
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