1. City and state in which the training was held:
    
2. Number of participants:
   Approximate number of participants: male    female
   Approximate number of participants: Caucasian    African-American
      Hispanic-American    Other
    
3. Number of agencies represented by trainers:   Please list these agencies:
   
    
4. Number of agencies represented by participants:   Please list these agencies:
   
    
5. What was the length of your program?    days    hours
    
6. What was the agenda of your training program? (You may copy and paste)
   
    
7. Please describe the goals and objectives of your program.
   
    
8. Please check the modules, exercises, fact sheets, and presentations you distributed or used during this program.
   

   Module 1               Exercises: 1.1 1.2 1.3 1.4 1.5 1.6   Presentations: 1 1.1 1.2 1.3 1.4     Video

   Module 2               Exercises: 2.1 2.2 2.3 2.4 2.5 2.6 2.7   2.8 2.9 2.10 2.11 2.12 2.13   Fact Sheets: 2.1 2.2 2.3 2.4 2.5 2.6 2.7   2.8 2.9 2.10         Presentations: 2 2.1 2.2 2.3

   Module 3               Exercises: 3.1 3.2 3.3 3.4 3.5 3.6 3.7   3.8 3.9           Fact Sheets: 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Presentations: 3 3.1 3.2 3.3 3.4 3.5

   Module 4               Exercises: 4.1 4.2 4.3 4.4 4.5 4.6 4.7   4.8 4.9 4.10 4.11       Fact Sheets: 4.1 4.2 4.3 4.4 4.5 4.6 4.7   4.8 4.9 4.10 4.11       Presentations: 4 4.1 4.2 4.3 4.4 4.5

   
    
9. Which case studies, if any, did you use? check the appropriate number(s)

   1	2	3	4	5	6	7	8	9	10
   11	12	13	14	15	16	17	18	19	20
   21	22	23	Presentation 5

   
    
10. How well did the exercises engage participants? If you adapted the exercises, please tell us what you did in question 19.
    
     
11. Did you invite a guest speaker to make a presentation during your program? From where?
    
     
12. Did you have any unexpected challenges or difficulties with your program?
    
     
13. How would you summarize the participants’ reactions to this program?
    
     
14. Did you use the pre- and post-test questions to evaluation learning? yes no
    If yes, please summarize what you learned from them.
    
     
15. Do you have plans to use these materials in the future? yes no
    Which materials are you most likely to use? Why?
    
     
16. How well did this material assist you in meeting a need for training in your agency?
    very well
    pretty well
    a little
    not at all
     
17. How well did this material assist you in moving your agency into new roles and responsibilities?
    very well
    pretty well
    a little
    not at all
     

We would like to share any suggestions you provide to the following questions with other trainers. You are welcome to mail, e-mail or fax this information as well.

18. What could improve these materials?
    
     
19. What specific adaptions did you make to the exercises to meet your needs?
    
     
20. What advice do you have for other trainers who might use these materials?
    
     
21. Do you have any questions or comments about the materials or your training experiences?
    
    

If you would like us to contact you please provide your e-mail address
OR send an e-mail with your question to the e-mail address listed below.