2017 Fall Convention - What Every Psychologist Should Know About Washington's Death With Dignity Law - Judith Gordon, Ph.D. and Dwight Moore, Ph.D.

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* 1. First & Last Name

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* 2. Email Address? Your CE Certificate will be sent here

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* 3. Please expedite my CE Certificate by the date below (a calendar field). You will be emailed an invoice for $15 that must be paid online before your certificate is issued. Your certificate will list all sessions you completed.

Yes

Date

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* 4. A. Program (1 strongly disagree - 5 Strongly Agree)

	1	2	3	4	5
Overall, the program met or exceeded my expectations	Overall, the program met or exceeded my expectations 1	Overall, the program met or exceeded my expectations 2	Overall, the program met or exceeded my expectations 3	Overall, the program met or exceeded my expectations 4	Overall, the program met or exceeded my expectations 5
I gained new knowledge as a result of this CE program	I gained new knowledge as a result of this CE program 1	I gained new knowledge as a result of this CE program 2	I gained new knowledge as a result of this CE program 3	I gained new knowledge as a result of this CE program 4	I gained new knowledge as a result of this CE program 5
Length of the program was adequate	Length of the program was adequate 1	Length of the program was adequate 2	Length of the program was adequate 3	Length of the program was adequate 4	Length of the program was adequate 5
The program description was accurate	The program description was accurate 1	The program description was accurate 2	The program description was accurate 3	The program description was accurate 4	The program description was accurate 5
Audio/Visual aids were helpful	Audio/Visual aids were helpful 1	Audio/Visual aids were helpful 2	Audio/Visual aids were helpful 3	Audio/Visual aids were helpful 4	Audio/Visual aids were helpful 5
Handouts were current and useful	Handouts were current and useful 1	Handouts were current and useful 2	Handouts were current and useful 3	Handouts were current and useful 4	Handouts were current and useful 5

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* 5. A. Content (1 Not Useful - 5 Very Useful)

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How Useful was the content of this CE program for your practice or other professional development?	How Useful was the content of this CE program for your practice or other professional development? 1	How Useful was the content of this CE program for your practice or other professional development? 2	How Useful was the content of this CE program for your practice or other professional development? 3	How Useful was the content of this CE program for your practice or other professional development? 4	How Useful was the content of this CE program for your practice or other professional development? 5

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* 6. A. Content (1 Very Little - 5 A Great Deal)

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How much did you learn as a result of this CE Program?	How much did you learn as a result of this CE Program? 1	How much did you learn as a result of this CE Program? 2	How much did you learn as a result of this CE Program? 3	How much did you learn as a result of this CE Program? 4	How much did you learn as a result of this CE Program? 5

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* 7. B. Course Objectives (please indicate how well objectives were met, 1 strongly disagree - 5 Strongly Agree)

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1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards	1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards 1	1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards 2	1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards 3	1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards 4	1) Explain how the Washington Death With Dignity law works, including eligibility and safeguards 5
2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law	2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law 1	2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law 2	2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law 3	2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law 4	2) Discuss the distinction between suicide and physician aid in dying, and discuss demographics and characteristics of people using the law 5
3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations	3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations 1	3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations 2	3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations 3	3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations 4	3) Explain the role psychologists can play, the purpose of the psychological evaluation, and the guidelines for evaluations 5
4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death.	4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death. 1	4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death. 2	4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death. 3	4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death. 4	4) Demonstrate an understanding of the APA ethical principles relevant to end of life care and decision making, including awareness of personal attitudes and beliefs about facing death. 5

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* 8. Evaluation of faculty in stated area (1 strongly disagree - 5 Strongly Agree)

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Presenter(s) seemed knowledgeable concerning topics covered	Presenter(s) seemed knowledgeable concerning topics covered 1	Presenter(s) seemed knowledgeable concerning topics covered 2	Presenter(s) seemed knowledgeable concerning topics covered 3	Presenter(s) seemed knowledgeable concerning topics covered 4	Presenter(s) seemed knowledgeable concerning topics covered 5
Presenter(s) were well prepared/organized	Presenter(s) were well prepared/organized 1	Presenter(s) were well prepared/organized 2	Presenter(s) were well prepared/organized 3	Presenter(s) were well prepared/organized 4	Presenter(s) were well prepared/organized 5
Presenter(s) answered questions satisfactorily	Presenter(s) answered questions satisfactorily 1	Presenter(s) answered questions satisfactorily 2	Presenter(s) answered questions satisfactorily 3	Presenter(s) answered questions satisfactorily 4	Presenter(s) answered questions satisfactorily 5
Content was presented clearly and effectively	Content was presented clearly and effectively 1	Content was presented clearly and effectively 2	Content was presented clearly and effectively 3	Content was presented clearly and effectively 4	Content was presented clearly and effectively 5
Presenter(s) were responsive to questions and comments	Presenter(s) were responsive to questions and comments 1	Presenter(s) were responsive to questions and comments 2	Presenter(s) were responsive to questions and comments 3	Presenter(s) were responsive to questions and comments 4	Presenter(s) were responsive to questions and comments 5
Presenter(s)’ teaching style was effective	Presenter(s)’ teaching style was effective 1	Presenter(s)’ teaching style was effective 2	Presenter(s)’ teaching style was effective 3	Presenter(s)’ teaching style was effective 4	Presenter(s)’ teaching style was effective 5
Content presented was applicable to my practice	Content presented was applicable to my practice 1	Content presented was applicable to my practice 2	Content presented was applicable to my practice 3	Content presented was applicable to my practice 4	Content presented was applicable to my practice 5

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* 9. As a result of attending this course, I see the value to me in the following ways (check all that apply):

I gained one or more specific ideas that I can implement in my area of practice.

I learned a new approach to my practice.

It may help me do a better job.

I do not see the impact of this course on my job.

Other (please specify)

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* 10. By attending this course, I believe (check all that apply):

I was able to update my skills.

I acquired new and/or advanced skills.

I have better knowledge upon which to base my decisions/actions in the practice setting.

I am reconsidering my views toward the topic(s) presented.

The topic presented was appropriate, but I am undecided as to my own views.

Other (please specify)

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* 11. Logistics/Staff (1 strongly disagree - 5 Strongly Agree)

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The enrollment was smooth and efficient	The enrollment was smooth and efficient 1	The enrollment was smooth and efficient 2	The enrollment was smooth and efficient 3	The enrollment was smooth and efficient 4	The enrollment was smooth and efficient 5
Staff was responsive and helpful	Staff was responsive and helpful 1	Staff was responsive and helpful 2	Staff was responsive and helpful 3	Staff was responsive and helpful 4	Staff was responsive and helpful 5
The quality of the facilities was adequate	The quality of the facilities was adequate 1	The quality of the facilities was adequate 2	The quality of the facilities was adequate 3	The quality of the facilities was adequate 4	The quality of the facilities was adequate 5

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* 12. Comments and recommendations for change if program is presented again (e.g. length, handouts, format, etc.)?

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* 13. Suggestions for future program topics or other general comments? (please print legibly

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* 14. I am interested in serving on the Board of Trustees:

Yes

The next page has a few questions regarding the overall convention - These are not required but we would appreciate your input.