Your feedback is very important to us. We developed this form so that you can let us know what you feel is working well and what concerns you would like addressed. The form should only take about 3-6 minutes to complete, depending on how much feedback you choose to give. The more specific your comments, the better we will be able to address your concerns.  Responses are anonymous; no one will know how you responded.  Thank you in advance for your time and cooperation.

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* 1. Please select your site:

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* 2. Please specify the date of the CBL session:

Date

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* 3. Please identify your CBL group (letter and number). (This information will be kept confidential and is only used to help identify the faculty member(s) who have been assigned to your section.)

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* 4. Are you providing feedback on the faculty member who was assigned to your group, on another faculty member with whom you worked during this CBL session, or on the session in general? (Check all that apply)

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* 5. What is/are the name(s) of the faculty member(s) on whom you are providing feedback?

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* 6. How would you rate the quality of the session?

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* 7. Is there anything you would have liked more help on during the session?

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* 8. Is there anything on which you would have liked additional clarification?

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* 9. Do you have any comments on the adequacy of the resources (e.g., tools, equipment, audiovisual, facilitators, etc.)?

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* 10. What, if anything, would you like to see changed for the next session?

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* 11. Other Comment(s):

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* 12. Which year are you in?

Thank you very much for your feedback!

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