Course Evaluation

Your input will help us to improve this course. Answer the questions Date:
as honestly and completely as possible. Please mark only one answer
per row. Place a dark mark that covers the box completely.

1. Your gender 7. How useful was the Personal Change Plan in

Male helping you meet your goals for the course?
Female Very useful
Useful
2. Your age Not useful
15-19
20-29 8. How useful were the Class Discussions in
30-39 helping you meet your goals for the course?
40-49 Very useful
50-59 Useful
60+ Not useful

3. Your ethnicity 9. How useful were the Small Group Activities in
African-American helping you meet your goals for the course?
American Indian Very useful

Asian/Pacific Islander Useful

Hispanic/Latino Not useful

White/Caucasian
Other 10. How would you rate your facilitator in the area
of being prepared?
Excellent
4. Overall, how would you rate this course?
Good
Excellent
Average
Good
Poor
Average
Poor
11. How would you rate your facilitator in the area
of making participants feel comfortable?
5. How useful was the Participant Journal in Excellent
helping you meet your goals for the course?
Good
Very useful
Average
Useful
Poor
Not useful
12. How would you rate your facilitator in the area
of involving everyone in discussion?
6. How useful was the Homework in helping you
meet your goals for the course? Excellent
Very useful Good

Useful Average

Not useful Poor

© 2010 The Change Companies®

 Course Evaluation

13. How would you rate your facilitator in the area 17. How useful do you think the course
of explaining the material clearly? information will be to you in the future?
Excellent Very useful
Good Somewhat useful
Average Not at all useful
Poor
18. Have you or will you share your Participant
14. How would you rate your facilitator in terms of Journal with anyone outside the class?
overall quality? I have
Excellent I will
Good I will not
Average
Poor 19. Will you keep your Participant Journal after
the course ends?
15. How valuable was the course material in helping Yes
you change your behavior? No
Very valuable
Valuable 20. Do you feel this course helped you make a
change in your behavior?
Not at all valuable
Yes
16. How much did you learn from the course? No
I learned a lot
I learned a little bit
I learned nothing

Write your responses to the following three questions below.

21. How would you describe this course to a friend?

22. The thing I liked best about this course is…

23. The thing I liked least about this course is…

© 2010 The Change Companies®