TEMPLATE for CNE Events

Enter Name of Event and/or Description of the event, date, time other relevant information

Standard Language - Completing this post-test qualifies you to receive continuing nursing education contact hours. A Certificate of Completion will be sent to you via the email address you provide below.

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* 1. Please enter your email address.

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* 2. Please describe how well this educational activity met the Learning Outcomes outlined here: Participants will be able to:

Not al all

Somewhat

Almost Completely

Completely

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* 3. Enter question submitted by Nurse Planner.

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* 4. Enter question submitted by Nurse Planner.

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* 5. Enter question submitted by Nurse Planner.

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* 6. Enter question submitted by Nurse Planner.

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* 7. Rate the expertise / effectiveness of each presenter individually with four (4) being effective and one (1) being ineffective.

	1	2	3	4
Name of Presenter	Name of Presenter 1	Name of Presenter 2	Name of Presenter 3	Name of Presenter 4
Name of Presenter	Name of Presenter 1	Name of Presenter 2	Name of Presenter 3	Name of Presenter 4
Name of Presenter	Name of Presenter 1	Name of Presenter 2	Name of Presenter 3	Name of Presenter 4
Name of Presenter	Name of Presenter 1	Name of Presenter 2	Name of Presenter 3	Name of Presenter 4

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* 8. Were the following items disclosed to you prior to the beginning of the activity.

	YES	NO
Learning Outcome	Learning Outcome YES	Learning Outcome NO
Requirements for successful completion	Requirements for successful completion YES	Requirements for successful completion NO
Were Conflicts of interest or NO Conflicts of Interest disclosed?	Were Conflicts of interest or NO Conflicts of Interest disclosed? YES	Were Conflicts of interest or NO Conflicts of Interest disclosed? NO
Commercial Support	Commercial Support YES	Commercial Support NO

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* 9. Did you, as a participant, notice any commercial bias that was not previously disclosed in this presentation?

Yes

If yes, please describe the bias.

TEMPLATE for CNE Events

Enter Name of Event and/or Description of the event, date, time other relevant information

Question Title

* 1. Please enter your email address.

Question Title

* 2. Please describe how well this educational activity met the Learning Outcomes outlined here: Participants will be able to:

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* 3. Enter question submitted by Nurse Planner.

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* 4. Enter question submitted by Nurse Planner.

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* 5. Enter question submitted by Nurse Planner.

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* 6. Enter question submitted by Nurse Planner.

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* 7. Rate the expertise / effectiveness of each presenter individually with four (4) being effective and one (1) being ineffective.

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* 8. Were the following items disclosed to you prior to the beginning of the activity.

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* 9. Did you, as a participant, notice any commercial bias that was not previously disclosed in this presentation?

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* 10. Please provide comments or suggestions for this training or future trainings.

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* 11. In the box below, enter your name as you would like it to appear on your Certificate of Completion awarding you five (5) CNE contact hours.