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* 1. What is your name? (person filling out evaluation) - OPTIONAL 

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* 2. What is the participant's name? - OPTIONAL

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* 3. What is your contact information? (phone/email) - OPTIONAL

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* 4. Would you like to be contacted in regards to your evaluation? 

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* 5. If yes, how would you like to be contacted?

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* 6. What is today's date?

Date

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* 7. What type of program are you evaluating?

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* 8. What is the program name and number?

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* 9. Who is the program leader/coordinator?

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* 10. Program Information. Please select the appropriate ranking for each question.  3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

  3 2 1 N/A
Program registration process efficiency
Customer service during the registration process
Location of program
Program facility
Time of program
Day of program
Description of the program in the brochure was met 
Goals listed in the brochure were met 
Activities were age appropriate 
Communication of schedule/activities
Length of program (weeks)
Overall satisfaction of the program 

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* 11. Program leader/coordinator. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

  3 2 1 N/A
Prompt/Dependale 
Communication 
Friendly attitude
Enthusiasm
Professionalism 
Preperation and Instruction 
Ability to adapt activities 
Encouraged independence 
Overall satisfaction of their performance 

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* 12. Assisting staff. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

  3 2 1 N/A
Prompt/Dependable 
Communication 
Friendly attitude
Enthusiasm
Professionalism 
Preperation/Instruction
Ability to adapt activities
Encouraged independence
Overall satisfaction of their performance 

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* 13. Please list specific benefits received from participation in this program:

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* 14. Suggestions to improve this program:

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* 15. Do you have any suggestions for new activities?

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* 16. With 1 being the least likely and 10 being the most likely, how likely are you to recommend NWSRA programs and services to others?

1 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 17. Would you like to be added to the NWSRA email list for updates on the most current information?

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* 18. If you answered yes to the above question, please enter your email address below:

0 of 18 answered
 

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