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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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