Student Input Form

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* 1. Instructor code:

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* 2. SID (Facility Code):

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* 3. Class (e.g. AOA101) or Program:

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* 4. Date

Date

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* 5. This survey is used to provide input regarding instructors. Your opinion is important to us! Please rate your level of agreement with the following statements.

  strongly agree agree neutral disagree strongly disagree
I can apply the principles I learned.
Students are treated with respect.
I receive individual attention when requested.
Materials are adequate, relevant, appropriate and effective.
Instructor listens effectively to individuals and group discussion.
Instructor speaks clearly and effectively.
Instructor serves as an objective resource during meetings and trainings.

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* 6. What is your overall rating of the instructor's effectiveness/service received?

  almost always effective usually effective sometimes effective rarely effective almost never effective
The instructor is...

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* 7. Comments

T