Instructions: Please tell us about your experience by selecting your choices below. Thank you for your feedback.
 
*Numbers are for internal purposes only*
 
OMB Control No. 3095-0070
Expiration date 12/31/2026 

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1. Choose the location that hosted this public program. (Required.)

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2. Please provide the date of the program:

Date

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3. Name of the program you attended:

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4. Overall, I am satisfied with my public program experience. (181)

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5. How did you learn about this program?

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6. The program was well organized.

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7. The presenter(s) was engaging.

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8. Overall, the presenter(s) was effective. (188)

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9. Overall, the program met its stated objective(s). (186)

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10. How could this program be improved?

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11. Additional Comments:

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12. Sex:

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13. Age:

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14. Race and ethnicity (check all that apply):

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15. Hispanic, Spanish or Latino Origin?

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16. Additional Information:

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT: You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number.  Public burden reporting for this collection of information is estimated to be less than 5 minutes per response.  Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to National Archives and Records Administration (MP), 8601 Adelphi Rd, College Park, MD 20740-6001.  DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.

OMB Control No. 3095-0070   Expiration date 12/31/2026  

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