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On Demand Public Webinar Certificate Request
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1.
What is your first and last name, as you would like it to appear on your certificate?
(Required.)
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2.
Please provide the e-mail address where you would like your certificate to be e-mailed.
(Required.)
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3.
What is the title of the LSVT Global community On Demand webinar that you viewed?
(Required.)
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4.
What is the date that you viewed the LSVT Global community On Demand webinar?
(Required.)
Date / Time
Date
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Saturday
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5.
Do you attest to viewing the webinar for the full duration?
(Required.)
Yes
No
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6.
Please list 3 items that you learned from the webinar.
(Required.)
Learning Item #1
Learning Item #2
Learning Item #3
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7.
Please provide the name of your discipline, whether a student or professional (e.g. speech-language pathology, physical therapy, occupational therapy), so that your certificate can be formatted appropriately.
(Required.)
8.
Please rate the audio and visual quality of the webinar.
Excellent
Good
Acceptable
Poor
Horrible
Audio Quality
Excellent
Good
Acceptable
Poor
Horrible
Visual Quality
Excellent
Good
Acceptable
Poor
Horrible
Comments on audio and visual quality:
9.
If you have any suggestions for future webinar topics we would love your input! Please provide any suggestions below.
10.
If you have any additional comments, please include them below.
11.
If you have a question for an LSVT LOUD or LSVT BIG Faculty Instructor, please write it below and include your contact info (name, phone number and/or e-mail address) so we may reach out to you.
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