1.Please tell us the date and location of the course:

2.Please answer the questions below based on PARTICIPANT DEMOGRAPHIC (feel free to give us number estimates)

How many youth/young adults (18-25 years old) participated in the program?

How many students (attending undergraduate/graduate studies) participated in the program?

How many Baby Boomers participated in the program?

What is the total number of participants you had?

3.Please answer the questions below based on PARTICIPANT INTEREST

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Participants completed there course(s) without much difficulty

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Participants wanted to know learn more and were interested in becoming instructors

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Participants seemed engaged and interested throughout the course(s)

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

4.Please answer the following questions based on SETTING

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

The room was conducive to learning

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

The learning environment stimulated idea exchange

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Course materials were easy to follow and helped you instruct your class

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

5.How could this class have been improved to stimulate better participant interest?

6.Please fill out the information below so we can confirm your survey completion

Name

Phone Number

Email Address