1. Overall, how do you rate this program?
Excellent
Good
Average
Needs improvement
Poor

2. How did you find out about this program?
Website
From a professor/teacher
From a friend
From a colleague
Attended meeting of organization
Required
Saw a flier
Other

3. As a result of this program, which statement best describes your reaction:
I am more knowledgeable or better informed about this subject.
I was entertained and I enjoyed the program.
I was moved by the speaker.
It was thought provoking point of view with which I may or may not agree.
The program did not elicit a response.

4. How would you rate the discussion between the audience and the presenter?
Not applicable- was not discussion period.
Lively exchange of questions and answers, thoughts shared.
Polite, short question and answer session.
Limited discussion, needs improving.
Specify

5. What did you like best about the program?

6. What did you like least about the program?

7. Additional Comments

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Name
Address
City/State/zip
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