ACTIVITY EVALUATION FORM FOR CALIFORNIA MCLE
Please complete and return to Provider Please Print
Provider Name
Provider Phone #
Provider Address
Title of Activity
Date of Offering Site
Name of Participant (optional) First Last
Directions: On a scale of 1-5 (5 being the highest, best or most and 1 being the least, lowest or worst) rate by circling the number reflecting your opinion.
1. To what extent were your personal objectives satisfied?
Comments: 5 4 3 2 1
2. To what extent did the environment contribute to the learning experience?
3. To what extent did the written materials contribute to the learning experience?
4. To what extent were the objectives stated in the promotional literature or those stated at the beginning of the activity satisfied?
5. To what extent did the activity contain significant current intellectual or practical content?
Please rate the faculty on the same scale.
Overall Teaching Effectiveness
Effectivieness of Teaching Methods
Singnificant Current Intellectual or Practical Content
A. Instructor's Name:
5 4 3 2 1
Subject/Topic:
Comments:
B. Instructor's Name:
C. Instructor's Name:
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