VPS Evaluation Form

Please submit this form 6 – 9 weeks after the meeting.

Name*
First Last
Email*
Title of CME/CE Activity*
Chair / Presenter / Faculty*
Date of CME/CE Activity*
MM slash DD slash YYYY
1. This training gave me strategies I could use in my practice to improve my professional competence.*
2. I was able to transfer information from this training into my practice.*
3. An example of information I was able to transfer to my practice from this training is:*
4. My professional competence (available strategies) would be improved if I had training on:*
5. I get more out of the following types of learning (check all that apply):*
- Case Presentations
- Workshops
- Panel Discussions
- Video or Audio Presentations
- Formal Discussion Groups
- Self-Assessment Inventory
- Journals
- Monographs or Supplements
- Abstract Presentations