Child Impact Program for Static Video

Class Evaluation

Please take three minutes and provide us with feedback on the Child Impact Program. All responses are confidential and anonymous.

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* 1. Class Details

Date / Time of Class

Date

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* 2. Center that provide access/password to watch video

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* 3. Program overall

5 = Very Satisfied

4 = Satisfied

3 = Somewhat Satisfied

2 = Dissatisfied

1 = Very Dissatisfied

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* 4. Usefulness of information provided

5 = Very Satisfied

4 = Satisfied

3 = Somewhat Satisfied

2 = Dissatisfied

1 = Very Dissatisfied

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* 5. Information provided answered questions you had

5 = Very Satisfied

4 = Satisfied

3 = Somewhat Satisfied

2 = Dissatisfied

1 = Very Dissatisfied

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* 6. Effectiveness of the video in providing useful information

5 = Very Satisfied

4 = Satisfied

3 = Somewhat Satisfied

2 = Dissatisfied

1 = Very Dissatisfied