Feedback Form: Pediatric Feeding Foundations Program "*" indicates required fields 1Learning Objectives2Instructor and Content Ratings3Testimony/Review4Recommendations/Feedback5Marketing6CEUs and/or Certificates HiddenDate* MM slash DD slash YYYY The content of this course was consistent with the following stated learning objectives: Identify the body systems, medical conditions and developmental foundations that underpin feeding at all ages.* Strongly Disagree Disagree Neutral Agree Strongly Agree Describe how to conduct a thorough case history, oral motor assessment and feeding evaluation with children 6 months – 12 years of age.* Strongly Disagree Disagree Neutral Agree Strongly Agree Report how to collate assessment information and diagnose a paediatric feeding disorder to inform treatment plans.* Strongly Disagree Disagree Neutral Agree Strongly Agree Discuss treatment principles and techniques for responsive feeding therapy, oral sensory motor therapies, developmental progressions in feeding, and dysphagia management.* Strongly Disagree Disagree Neutral Agree Strongly Agree Identify the resources, tools, processes and professional support required to set-up a feeding clinic and provide feeding therapy.* Strongly Disagree Disagree Neutral Agree Strongly Agree We are sorry this course did not meet your expectations but we value your feedback! Please let us know how we can improve in this area. Please rate the following aspects of the course instructor, contents, and delivery: The style of presentation was conducive to learning.* Strongly Disagree Disagree Neutral Agree Strongly Agree The instructor demonstrated a thorough knowledge of the subject matter.* Strongly Disagree Disagree Neutral Agree Strongly Agree Materials provided and speaker interactions were effective in facilitating learning.* Strongly Disagree Disagree Neutral Agree Strongly Agree The scheduling of the course (time, day, month) was convenient.* Strongly Disagree Disagree Neutral Agree Strongly Agree Rate your ability BEFORE the course to utilize the knowledge/skills presented in the course.* Very Weak Weak Neutral Strong Very Strong Rate your ability AFTER the course to utilize the knowledge/skills presented in the course.* Very Weak Weak Neutral Strong Very Strong We are sorry this course did not meet your expectations but we value your feedback! Please let us know how we can improve in this area. Please provide your honest review of this course for others: What did you appreciate/enjoy about and/or learn from the course? What would your “testimony” be to others who are considering this course?* Would you give your permission for us to use your course feedback, with your name, in future materials about this course (testimonial on website and/or advertisements for the course)?* Yes, first and last name Yes, but first name only No We truly value your feedback. Please let us know how we can improve! What suggestions would you offer for improving this program? Would you recommend this course and instructor to your colleagues?* Yes No How will you utilize the knowledge and skills gained from this course to improve your practice? Please help us with our marketing efforts: How did you hear about this course offering? Email FaceBook Snail mail Twitter YouTube Instagram Friend Other Other: How do you prefer to hear about new course offerings? Email FaceBook Snail mail Twitter YouTube Instagram Friend Other Please list any other preferred methods to hear about new courses: CEU and/or Certificate choices: Please enter your full name exactly (must match your name from registration)* First Last Please enter your email address (must match your email from registration)* Enter Email Confirm Email In which profession(s) do you hold licensure?* Speech-Language Pathologist Occupational Therapist Physical Therapist SLP Assistant OT Assistant Dietician/Nutritionist Nurse Teacher Other Please list your other profession(s) separated by commas:* SLP Certificate and CEU Options* Generate my certificate and submit my completion to ASHA for CEUs. I attest that I have completed all course materials and requirements to earn the prescribed CEUs according to the standards of my professional organization. Generate my certificate only. I do not desire ASHA CEUs. I attest that I have completed all course materials and requirements to earn the prescribed CEUs according to the standards of my professional organization. Generic Certificate* Generate my generic certificate. I attest that I have completed all course materials and requirements to earn the prescribed CEUs according to the standards of my professional organization. In order to report your course completion to ASHA we require the following:Consent to share personal information (Name, Address, Email Address, ASHA ID) with ASHA. I understand I must be an ASHA member in good standing in order to receive ASHA CEUs.I hereby consent to have my personal information shared with ASHA for the purpose of granting ASHA CEUs. ASHA ID* To ensure proper assignment of ASHA CEUs please enter your ASHA ID: (If you are new to ASHA and don't yet have an ASHA ID, please enter "00000000") Note: This must be eight digits. 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