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Caregiver Feedback Form 2016

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Filling out this survey helps us maintain funding and provide training that meets your needs.

Question Title

* 1. Please enter the information below:

Name of Program:

Date:

Email:

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* 2. Zip Code (required):

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* 3. Ratings:

	100%	75%	50%	25%	0%
This session increased my knowledge and/or skills in this topic area related to caregiving by:	This session increased my knowledge and/or skills in this topic area related to caregiving by: 100%	This session increased my knowledge and/or skills in this topic area related to caregiving by: 75%	This session increased my knowledge and/or skills in this topic area related to caregiving by: 50%	This session increased my knowledge and/or skills in this topic area related to caregiving by: 25%	This session increased my knowledge and/or skills in this topic area related to caregiving by: 0%
The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by:	The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by: 100%	The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by: 75%	The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by: 50%	The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by: 25%	The session increased my ability to cope in this particular area as a caregiver or as someone who provides support to a caregiver by: 0%

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* 4. The presenter was:

Excellent

Good

Fair

Poor