Name of Course Completed:

Date of Course Completed:
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Name(s) of Training Center Teaching Staff (one per line):

Please rate the following elements ( 5  = excellent)	5	4	3	2	1
Program Content
Organization, Pace, And Flow
Not Too Basic, Not Too Complex
Increase Your Individual Awareness
Increased Your Confidence & Ability To Take Action
Training Center Teaching Staff
Subject Knowledge
Enthusiastic, Friendly
Sincere, Considerate, Helpful
Did You Enjoy The Lecture Style
Organized, Effective
Program Materials
Lecture Time Appropriate
Audiovisual Materials
Practical Stations
Skills Stations Enough Time
Equipment Supplied
Your Overall Score For The Course

What did you like most about this course?

What did you like least about this course?

Would you recommend this Course to others?
Yes No

Contact Information (optional):
Name:

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We welcome your comments and suggestions and will use them to improve our programs. Please add additional comments here if necessary.

Thank you for taking the time to care and for your continual support!

RELEASE OF COMMENTS

The undersigned, intending to be legally bound, hereby authorizes EMS Education Inc. and all of its subsidiaries and affiliates, their agents and associates to use for any lawful purpose, including illustration, advertising and publication in any manner, written comments of the undersigned shown above.  The undersigned hereby irrevocably consents to the unrestricted, repetitive use of such testimonials and waives the right to inspect or approve any finished product or advertising copy that may be used in connection therewith.