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Health Professionals

Asthma Basics for Schools - Feedback Form

Directions: Circle the one best response for each of the following statements.

HOW HELPFUL WAS THE PRESENTATION ON: Very helpful Helpful Don't know Unhelpful Very unhelpful
1. Defining the problem of asthma among school-age youth. 5 4 3 2 1
2. Identifying the causes and symptoms of asthma. 5 4 3 2 1
3. Describing the impact of asthma on student learning. 5 4 3 2 1
4. Identifying the asthma triggers. 5 4 3 2 1
5. Explaining how to control asthma. 5 4 3 2 1
6. Discussing how asthma-friendly is your school. 5 4 3 2 1
7. Describing how to handle an asthma episode. 5 4 3 2 1
8. Explaining the goals based on CDC's Strategies for Addressing Asthma within a Coordinated School Health Program. 5 4 3 2 1
9. Identifying Asthma Resources for School Health. 5 4 3 2 1
GENERAL QUESTIONS Strongly Agree Agree Neutral Disagree Strongly Disagree
10. The presentation was useful to me. 5 4 3 2 1
11. The presenter was knowledgeable and informative. 5 4 3 2 1
12. Overall, the quality of the presentation was good. 5 4 3 2 1

13. In your opinion, what part of this presentation was most valuable?
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

14. In your opinion, what part of this presentation was least valuable?
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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