Please provide the following information. Fields marked with an asterisk (*) must be filled out correctly in order for all information to be accepted.

          Name: *
          Phone #: *
          Email:

1. Name of the program? 

2. In general, how would you rate your overall satisfaction with this program?
          1 (very unsatisfied)
          2 (unsatisfied)
          3 (somewhat satisfied)
          4 (satisfied)
          5 (very satisfied)

3. In general, how would you rate your instructor's overall performance?
          1 (terrible)
          2 (not so good)
          3 (not bad)
          4 (good)
          5 (very good)

4. Do you have any comments/suggestions that would improve this particular program?

         

5. Would you refer this program to another person?
          Yes
          No