Continuing Education Evaluation

Please COMPLETE all items as requested. If not applicable, please just hit enter to continue. If you fail to provide a reliable e-mail address, we will be unable to provide your CEU.

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* 1. First Name?

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* 2. Last Name?

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* 3. Nursing License Number

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* 4. Admin ALF License Number

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* 5. Admin Skilled License Number

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* 6. Social Work License Number

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* 7. AADC, PT, OT or Other License Number

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* 8. Email Address (Non-VA or Gov)

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* 9. Please include your telephone number in case we need to reach you about missing or incorrect data. (XXX-XXX-XXXX)

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* 10. With 5 Stars the highest, how would you rate the Presentation?

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* 11. With 5 Stars being highest, how would you rate the Presenter?

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* 12. With 5 Stars being the highest, participant will be able to •Describe new ways to relate to others with different personality types

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* 13. With 5 Stars being the highest, will be able to •Understand the role of personality in interpersonal relations

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* 14. With 5 Stars being the highest, participants will be able to •Identify your own personality type and what each means.

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* 15. What is the CEU Word?

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* 16. What is the name of your current/previous employer if you are retired?

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* 17. Comments, Suggestions or Topics you would like to hear!

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