Program Evaluation Utilization Survey Form
Please share how you used, applied, or shared the program’s information or results, and what impact it had. Your feedback will help us improve future programs.
What is your primary role in relation to the program?
*
Participant
Facilitator/Instructor
Administrator
Other
How did you use the information or results from the program?
*
Applied directly to my work
Shared with colleagues or team
Used for decision making
Informed policy or procedures
Shared with external partners
Other
How frequently have you used the program’s information or results?
*
Very frequently
Frequently
Occasionally
Rarely
Never
With whom have you shared the program’s information or results?
*
Direct team members
Other departments
Leadership/Management
External partners
Community members
I have not shared the information
To what extent did the program’s information or results lead to changes in your work or organization?
*
No change
1
2
3
4
Significant change
5
1 is No change, 5 is Significant change
Please indicate your agreement with the following statements about the program.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The program provided practical information.
1
2
3
4
5
I found the results relevant to my needs.
6
7
8
9
10
The delivery method supported my learning.
11
12
13
14
15
I would participate in a similar program again.
16
17
18
19
20
What barriers, if any, limited your ability to use or share the program’s information or results?
Lack of time
Lack of resources
Organizational constraints
Not applicable
Other
How satisfied are you with the overall quality of the program?
*
1
2
3
4
5
How likely are you to recommend this program to others?
*
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
Please share any additional comments or suggestions for future programs.
Submit Survey
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