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* 1. What is your name? (person filling out evaluation) - OPTIONAL 

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* 2. What is the participant's name? - OPTIONAL

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* 3. What is your contact information? (phone/email) - OPTIONAL

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* 4. Would you like to be contacted in regards to your evaluation? 

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* 5. If yes, how would you like to be contacted?

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* 6. What is today's date?

Date

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* 7. What type of Virtual Program are you evaluating?

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* 8. What is the specific program name?

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* 9. Who is the program leader/coordinator?

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* 10. Program Information. Please select the appropriate ranking for each question.  3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

  3 2 1 N/A
Time of program
Day of program
Activities were age appropriate
Length of program season
Overall satisfaction of the program 

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* 11. Program leader/coordinator. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

  3 2 1 N/A
Prompt/Dependale
Friendly attitude
Enthusiasm
Professionalism 
Preperation and Instruction 
Ability to adapt activities 
Encouraged independence 
Overall satisfaction of their performance 

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* 12. Please list specific benefits received from participation in this Virtual Program:

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* 13. Suggestions to improve this Virtual Program:

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* 14. Do you have any suggestions for new Virtual Program ideas?

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* 15. Do you have any suggestions for new Activity Center activities?

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* 16. With 1 being the least likely and 10 being the most likely, how likely are you to recommend NWSRA Virtual Programs to others?

1 10
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 17. Would you like to be added to the NWSRA email list for updates on the most current information?

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* 18. If you answered yes to the above question, please enter your email address below:

0 of 18 answered
 

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