Skip to content
Continuing Education Participant Assessment and Course Evaluation
The Institute For Art and Living
The Painting Experience
You must submit this form to receive continuing education credit. The Certificate of Completion will be emailed to you within 15 days of receipt.
*
1.
Contact Information
(Required.)
Name
Address
City/Town
State/Province
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/Postal Code
Email Address
Phone Number
*
2.
License Type
(Required.)
LMFT
LCSW
LPCC
LEP
RN
Other (please specify)
*
3.
License Number
(Required.)
Course Title
Awakening the Creative: The Painting Experience
*
4.
Course Date
(Required.)
*
5.
Course Location
(Required.)
*
6.
Course Instructor(s)
(Required.)
Participant Course Assessment
Write a paragraph or two on each of the following topics.
See
Program Goals and Learning Objectives
.
*
7.
Describe the key concepts and skills presented in this course.
(Required.)
*
8.
List the key learning objectives of this course in measurable terms, and assess the degree to which each of these objectives was met.
(Required.)
*
9.
What is the most important single concept that you have gained from this course that you will use in your healthcare setting?
(Required.)
*
10.
How might you apply it in your practice?
(Required.)
11.
How does process painting offer you the opportunity to reflect on your own implicit biases?
Participant Course Evaluation
*
12.
What was your primary reason for selecting this program?
(Required.)
Subject was of interest
Colleague recommended
Reputation of leader(s)
Important to job activities
Other (please specify)
*
13.
Was the course consistent with its objectives and title?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
14.
Was this course appropriate to your level of education and experience?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
15.
Was this course appropriate to your licensure level?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
16.
Was the course appropriately challenging?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
17.
Did the course expand your knowledge in this topic?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
18.
Was the information presented current and accurate?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
19.
Was the course taught at the promised level?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
20.
Was the material relevant to your professional activities?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
21.
Did the instructor know the subject matter?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
22.
Were the instructor(s) well prepared?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
23.
Were the instructor(s) attentive to questions?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
24.
Would you attend another course given by this leader?
(Required.)
Absolutely not
Probably not
Uncertain
Somewhat
Absolutely
*
25.
How would you rate the overall value of the program?
(Required.)
Poor
Fair
Good
Excellent
*
26.
How would you rate the effectiveness of the presentation, including use of experiential learning?
(Required.)
Poor
Fair
Good
Excellent
*
27.
How would you rate the suitability and/or usefulness of instructional materials?
(Required.)
Poor
Fair
Good
Excellent
*
28.
If it was an onsite course, how would you rate the location, facilities and administration of the program?
(Required.)
Not Applicable - my course was online
Poor
Fair
Good
Excellent
*
29.
If it was an online course, how would you rate the instructor's ability to utilize course-appropriate technology to support participant learning?
(Required.)
Not Applicable - my course was onsite
Poor
Fair
Good
Excellent
*
30.
Overall, how much did you learn as a result of this CE program?
(Required.)
Very little
Less than expected
A moderate amount
More than expected
A great deal
31.
What could have been improved or added?
*
32.
Would you prefer a printed version of your certificate of completion sent to you?
(Required.)
Yes
Not needed, a pdf is fine
33.
Please list any additional comments, special instructions or any future course suggestions you might have.
Thank you for participating in The Institute For Art and Living’s Continuing Education program, we look forward to providing for your Continuing Education needs in the future. The Institute For Art and Living maintains responsibility for this program and its content.
Continuing Education Coordinator, CE@processarts.com, Institute For Art and Living, PO Box 309, Fairfax, CA 94978 415-488-6880.
Remember to click on the "Submit" button below!
If the form is complete -- no required questions left unanswered -- once you hit submit, it will say "Thank You" and the form will disappear. If you leave the page before the submission is complete, you will lose all your written responses.