KELL - SCHEDULE GRID TESTER
How would you like your name to appear on your certificate?
Profession
Select Your Profession
Addictions & Substance Abuse Counselor
Counselor
Employee Assistance Professionals
Marriage and Family Therapist
Nurse
Other
Physician
Psychologist
Social Worker
Psychologist
Counselor
Marriage & Family Therapist
Addictions Professional
Social Worker
Other
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How many credit hours did you complete?
Credit Hours (maximum: 5.0)
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
I agree
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Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours.
Notice to OhioLicensees: In order for us to report your hours to CE Broker, you MUST provide us with your Ohio alpha-numeric license number (e.g. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours.Â
CHES MEMBERS ONLY -- Please enter your CHES ID#
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Please rate your satisfaction with the content and quality of the program:
Very Satisfied
Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Dissatisfied
Very Dissatisfied
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Was the educational content scientifically sound?
Yes
No
If no, please explain...
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Did you perceive any commercial bias or influence in the educational content?
Yes
No
If yes, what...
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Did this program improve your competence or performance?
Yes
No
If yes, how...
If no, please explain...
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What did you learn that will help you in your practice?
The program was up-to-date and relevant to my professional practice.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
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Were the following objectives met?
They're just trying to get 111111
Yes
No
I don't know
Were the following objectives met?
22222222222222
Yes
No
I don't know
Were the following objectives met?
333333333333333
Yes
No
I don't know
Were the following objectives met?
44444444444444
Yes
No
I don't know
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Was the location suitable?
Yes
No
Not applicable
The facilities were conducive to learning.
Yes
No
Not applicable
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Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Yes
No
I don't know
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Yes
No
I don't know
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Yes
No
I don't know
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Yes
No
I don't know
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Rate the following for all instructors
Instructor was knowledgeable about the content.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Not applicable
Rate the following for all instructors
Instructor presented the subject matter clearly.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Not applicable
Rate the following for all instructors
Instructor was responsive.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Not applicable
Rate the following for all instructors
Instructor used technology, hand outs and other learning aids effectively.
Strongly Agree
Agree
I don't know
Disagree
Strongly Disagree
Not applicable
Additional questions about the instructor(s)
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What questions are you having in your practice that you would like to see addressed in an educational activity?
Were questions, concerns and accommodations were addressed efficiently and in a timely manner?
Additional comments, questions or concerns.
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How did you attend this course?
Live Online/Live Virtual
Enduring (Recorded) Online
Both
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