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* 1. Your Name

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* 2. Name of Instructor/Presenter

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* 3. Location of training

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* 4. Which program did you take?

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* 5. Date(s) of program

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* 6. Please rate the program

  Strongly Dissatisfied Average Strongly Satisfied
The overall content of the program
The knowledge and presentation skills of the presenter
The facility and accommodations
The content and quality of the program materials
The relevance of the content to my professional life
The relevance of the content to my personal life

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* 7. How well did this experience meet your needs?

  Strongly Dissatisfied Average Strongly Satisfied
Survival - Was it a safe environment?
Love & Belonging - Did I build relationships with other participants and the instructor?
Power - Did I learn relevant, useful information?
Freedom - Was I afforded choices, independence and creativity?
Fun - Did I have fun?

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* 8. What I liked about the program?

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* 9. What could be done better next time:

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* 10. Are you interested in further programs?

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* 11. Do you want to be contacted regarding your program experience? If so, please provide your contact details.

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* 12. Please provide any additional comments you may have concerning the program and whether or not it met your expectations.

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