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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
(Required.)
Date / Time of Class
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
*
2.
Center that provide access/password to watch video
(Required.)
Center for Life Management
Community Partners
Greater Nashua Mental Health Center
Lakes Region Mental Health Center - Laconia
Lakes Region Mental Health Center - Plymouth
Mental Health Center of Greater Manchester
Monadnock Family Services
Northern Human Services - Groveton
Northern Human Services - Littleton
Northern Human Services - Wolfeboro
Riverbend Community Mental Health
Seacoast Mental Health Center - Exeter
Seacoast Mental Health Center - Portsmouth
West Central Behavioral Health - Claremont
West Central Behavioral Health - Lebanon
West Central Behavioral Health - Newport
3.
Program overall
5 = Very Satisfied
4 = Satisfied
3 = Somewhat Satisfied
2 = Dissatisfied
1 = Very Dissatisfied
4.
Usefulness of information provided
5 = Very Satisfied
4 = Satisfied
3 = Somewhat Satisfied
2 = Dissatisfied
1 = Very Dissatisfied
5.
Information provided answered questions you had
5 = Very Satisfied
4 = Satisfied
3 = Somewhat Satisfied
2 = Dissatisfied
1 = Very Dissatisfied
6.
Effectiveness of the video in providing useful information
5 = Very Satisfied
4 = Satisfied
3 = Somewhat Satisfied
2 = Dissatisfied
1 = Very Dissatisfied
Current Progress,
0 of 13 answered