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* 1. Facilitator Name:

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* 2. Co-Facilitator Name:

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* 3. Date Training Completed:

Date

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* 4. Province Training was Held:

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* 5. Treatment Centre/First Nation/Organization Trained:

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* 6. What modules did you facilitate:

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* 7. Have you learned anything new about yourself since presenting this last time?

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* 8. Were you able to address all the questions you received during the dialogue?

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* 9. If not, what will you do differently next time to be able to answer similar questions?

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* 10. How confident did you feel in your understanding of the material presented? (on a scale of 1-5 with 1 low and 5 high)

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* 11. Approximately how much time did you spend preparing to Facilitate?

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* 12. Did you:

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* 13. Did you develop any new activities?

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* 14. If yes, please describe the activity?

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* 15. If yes, where did you insert the activity into the training?

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* 16. Did you have to assist participants in using the QR survey code:

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* 17. Were any manual evaluations completed?

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* 18. If yes, how many?

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* 19. Did you enter them into survey monkey?

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* 20. If no, why? or who did?

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* 21. Did you provide certificates to those who completed the course?

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* 22. If no, why? Who did?

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* 23. Did you feel you met the objectives in teaching the modules?

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* 24. What could you have done better?

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* 25. What did you enjoy the most about facilitating the Life is Sacred program?

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* 26. What is your confidence level in presenting the training this time? (on a scale of 1-5 with 1 low and 5 high)

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* 27. Please list the names of participants who received Certificates (for database/statistical purposes)

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