Name of Student
Date of Event
Type of Event (Choose One)
What did you learn or how did you respond to the program or presentation?
Place a choose the selection that best indicated your response to the educational value of the event you have just attended.
Excellent Educational Experience
Good Educational Experience
Poor Educational Experience
No Educational Value
By typing my initials below in the box below, I certify that I have attended the event listed above and that I have truthfully respresented my attendance on this form.