Evaluation Consent Form
Please read and agree to the terms before proceeding with the evaluation process.
Full Name
First Name
Last Name
Email Address
example@example.com
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluation Questions
Please provide your feedback by answering the following questions:
On a scale of 1-10, how would you rate the overall effectiveness of the program?
1 (Not Effective)
1
2
3
4
5
6
7
8
9
10 (Highly Effective)
10
1 is 1 (Not Effective), 10 is 10 (Highly Effective)
What specific aspects of the program did you find most beneficial?
In what areas do you feel the program could be improved?
How likely are you to recommend this program to others?
Very Likely
Likely
Neutral
Unlikely
Very Unlikely
Do you have any additional comments or suggestions for the improvement of the program?
Anything to add
Submit
Should be Empty: