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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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Department of Health
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National
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National Heart, Lung, and Blood
Institute