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* 1. Rate the Overall Program  – Select One:

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* 2. Identify two new ideas you gained and how do you plan to implement these new ideas in your program?

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* 3. What would you suggest for future professional development to help you in your School Based Medicaid Program?

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* 4. Rate the Organization and flow of presentation (General Session)  Select one:

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* 5. Rate the Quality of materials and visual aids (General Session) - Select one:

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* 6. Rate the Stated Objectives met (General Session) - Select One:

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* 7. Rate the Organization and flow of presentation (Breakout Session A: Cost Settlement) Select One:

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* 8. Rate the Quality of materials and visual aids (Breakout Session A:  Cost Settlement) - Select One:

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* 9. Rate the Stated objectives met (Breakout Session A: Cost Settlement) - Select One:

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* 10. Rate the Organization and flow of presentation (Breakout Session B: Random Moment Time Study) Select One:

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* 11. Rate the Quality of materials and visual aids (Breakout Session B:  Random Moment Time Study) Select One:

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* 12. Rate the Stated objectives met (Breakout Session B: Random Moment Time Study) Select One:  

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* 13. Rate the Organization and flow of presentation (Breakout Session C: Compliance) - Select One:

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* 14. Rate the Quality of materials and visual aids (Breakout Session C:  Compliance) Select One:

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* 15. Rate the Stated objectives met (Breakout Session C: Compliance) - Select One: 

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* 16. Give us an example of how you have used your Medicaid Reimbursement dollars to help students with disabilities over the past year?

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* 17. Other general comments:

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* 18. Select training attended:

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* 19. Contact Information and Title (optional):

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