EVALUATION FORM

In order to improve the quality of our next program, we would appreciate receiving your feedback. 

Please feel free to make comments.  We thank you for your cooperation.

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* 1. On a scale of 1 (poor) to 5 (excellent), how well were you able to achieve the session objectives?

  1 2 3 4 5 N/A
A. List three benefits of advocacy with legislative or government leaders at the local, state and federal levels.
B. Demonstrate knowledge of the principles of advocacy and tools you can use.
C. Describe three compelling outcomes from the Strong Start project in birth centers to share with consumers, physicians and hospitals, and elected officials.
D. Discuss advantages of various advocacy meeting locations, including district offices, state lobbying events, Washington DC, and your birth center.

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* 2. On a scale of 1 (poor) to 5 (excellent), please rate the TEACHING EFFECTIVENESS of the presenter.

  1 2 3 4 5 N/A
A. Jill Alliman, DNP, CNM, FACNM
B. Amber Allen, BA
C. Cynthia Flynn, PhD, CNM, FACNM

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* 3. On a scale of 1 (poor) to 5 (excellent), please rate the effectiveness of the TEACHING METHODS used.

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* 4. On a scale of 1 (poor) to 5 (excellent), please rate how well was the PROGRAM MATERIAL ORGANIZED.

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* 5. On a scale of 1 (poor) to 5 (excellent), please rate the session OVERALL.

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* 6. What part of the program provided the most helpful information?

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* 7. What additional information would have been helpful?

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* 8. Additional comments

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* 9. Name (submit if applying for continuing education)

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* 10. Email (optional)

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