Thank you for hosting and leading a workshop. Your feedback is important to us. Please take a moment to complete this survey.

If you have any questions or additional feedback, please email info@agingresearch.org

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* 1. What is your name and title?

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* 2. What was the location of the workshop?

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* 3. What was the date and time of the workshop?

Date / Time

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* 4. Number of people who participated

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* 5. On a scale of 1 to 5, how helpful were the following materials provided in this kit?

  1- Not at all 2- A little 3- Somewhat 4- Very 5- Extremely
Leader’s Guide
PowerPoint slides
"Pocket film"
Quick Guide to Vaccination
Quiz

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* 6. What were the strengths of this kit?

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* 7. What improvements could be made?

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* 8. Was there any information or concept covered that you or the participants found to be confusing?

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* 9. What information or concepts were not covered that you think should have been?

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* 10. What suggestions did the participants offer for improving the workshop?

T