Feedback Form – Crash Course for Hearts and Hands

1Learning Objectives

2Instructor and Content Ratings

3Testimony/Review

4Recommendations/Feedback

5Certificate

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Date*

MM slash DD slash YYYY

The content of this course was consistent with the following stated learning objectives:

Outline the 5 major areas to address in Pediatric Feeding Assessment.*

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Demonstrate techniques for assessment and treatment of sensorimotor and behavioral capabilities in pediatric patients.*

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Explain the rationale in prioritizing areas to address in treatment.*

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Discuss ways to facilitate carryover of therapeutic techniques in the home setting.*

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

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 CEU Espresso and/or Jennifer Meyer, to use your feedback, with your name, in future promotional materials?*

Yes, first and last name

Yes, but first name only

We truly value your feedback. Please let us know how we can improve!

What suggestions would you offer for improving this program?

How will you utilize the knowledge and skills gained from this course to improve your practice?

In your current position, what are your most pressing areas of need for Professional Development?

CEU and/or Certificate choices:

I attest:*

I have completed all course requirements to earn the prescribed CEUs and/or Certificate of Completion according to the standards of my professional organization.

Please enter your full name. (must match your name from registration)*

First Last

Please enter your mobile number:

May we text you with questions, if necessary?

Yes

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

SLP Assistant

Occupational Therapist

OT Assistant

Physical Therapist

Dietician/Nutritionist

Nurse

Dental Hygienist

Dentist

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.
Note that by requesting ASHA CEUs you give consent to have your personally identifying information shared with ASHA for the purpose of awarding ASHA CEUS.

Generate my certificate only. I do not desire ASHA CEUs.

Please enter your ASHA ID:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Certificate of Completion*

Generate my Certificate of Completion

AOTA Certificate of Completion*

Generate my AOTA Certificate of Completion