2022 Summer Training Institute on Autism Feedback Form

2022 Summer Training Institute on Autism Feedback Form

We would greatly appreciate your feedback on our Summer Training Institute on Autism.

Certificates of Attendance will be emailed to you based on the attendance records from Zoom. You can earn a MAXIMUM of 5 hours for each day you attend. Lunch and afternoon break do not count towards credit.

Date of Attendance*

Select the date of the Summer Institute you attended. You will need to fill out a new feedback form and request a certificate for each day you attend.

Select

Role*

What is your job title? For example, teacher, SLP, family member, agency personnel.

Institute Feedback Survey Questions

Question 1- Increase Knowledge*

To what extent did the training increase your knowledge? 1= Not at all <---------> 6 = Greatly

Select or enter value

Question 2- Meet Objectives*

To what extent did the training meet its intended objectives? 1= Not at all <---------> 6 = Greatly

Select or enter value

Question 3- Use what you learned*

To what extent will you use what you learned from the training? 1= Never <---------> 6 = Always

Select or enter value

Question 4- Recommend to others*

To what extent will you recommend the training to others? 1= Never <---------> 6 = Always

Select or enter value

Overall Rating*

What is your overall rating of today's session. 1 = Poor <--------> 6 = Excellent

Select or enter value

Comments

Please share any comments you have.

What Training Topics Would you LIke to See

Please list any topics you would like to see the FSU Autism Institute provide in the future.

FOR ASHA CEUs ONLY

This is ONLY for Speech-Language Pathologists and Audiologist who wish to earn CEUs from the American Speech-Language Hearing Association (ASHA).

ASHA CEUs are given for those who attend at least 80% of a full day.

Do you want ASHA CEUs?

Select or enter value

Last Name

First Name

ASHA Number

If you want ASHA CEUs, please put your ASHA number.

Address

City

State

Zip/Postal Code

Country

Phone

Please list a good contact number in case we have questions.

Attendance Time

You may receive a maximum of 5 hours or 0.5 ASHA CEUs per day -- lunchtime and afternoon break time do not count towards CE Credits.

You must be present in Zoom for at least 80% of the 5 hours of content time to receive the 0.5 ASHA CE Credit for each day. Partial credit will not be given to those who do not attend 80% or more of a full day.

Send me a copy of my responses

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