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?
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________