1 1 1 1 5 5 5 5 4 4 4 4 3 3 3 3 2 2 2 2 1 1 1 1 5 5 5 5 4 4 4 4 3 3 3 3 2 2 2 2 1 1 1 1 III. Overall Activity Evaluation: Course material was appropriate to my education, experience and/or 5 4 3 2 1 licensure level Course material was relevant to my professional needs/scope of practice 5 4 3 2 1 Course material was current 5 4 3 2 1 The course materials presented the course content effectively 5 4 3 2 1 Handouts and teaching aids enhanced the content of the course 5 4 3 2 1 The location of this activity was suitable 5 4 3 2 1 The facilities were conducive to learning 5 4 3 2 1 The instructions for requesting accommodations for a disability were 5 4 3 2 1 clear Program administration questions or concerns were addressed effectively 5 4 3 2 1 and in a timely manner I plan to make changes in my practice based on the information in this activity Yes, planned changes include: (Check all that apply): Modify my approach to referral or co-management Modify my patient education information/materials Modify elements of staff training or treatment protocols in my practice Other: ____________________________________________________________ No. Please explain _________________________________________________________ What is your level of commitment to making the changes stated above? Very committed Somewhat committee Not very committed Do not expect to change I would recommend this activity to my peers 5 4 3 2 1 How did you learn about this activity? Brochure E-mail Professional Journal NKF Web site Co-Worker Direct Mail Don’t Recall Other_________
1 1 1 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 III. Overall Activity Evaluation: Course material was appropriate to my education, experience and/or licensure level 5 4 3 2 1 Course material was relevant to my professional needs/scope of practice 5 4 3 2 1 Course material was current 5 4 3 2 1 The course materials presented the course content effectively 5 4 3 2 1 Handouts and teaching aids enhanced the content of the course 5 4 3 2 1 The location of this activity was suitable 5 4 3 2 1 The facilities were conducive to learning 5 4 3 2 1 The instructions for requesting accommodations for a disability were clear 5 4 3 2 1 Program administration questions or concerns were addressed effectively and in a timely manner 5 4 3 2 1 I plan to make changes in my practice based on the information in this activity Yes, planned changes include: (Check all that apply): Modify my approach to referral or co-management Modify my patient education information/materials Modify elements of staff training or treatment protocols in my practice Other: ____________________________________________________________ No. Please explain _________________________________________________________ What is your level of commitment to making the changes stated above? Very committed Somewhat committee Not very committed Do not expect to change I would recommend this activity to my peers 5 4 3 2 1 How did you learn about this activity? Brochure E-mail Professional Journal NKF Web site Co-Worker Direct Mail Don’t Recall Other_________
Accreditation%20Application%20for%20CNSW%20CE%20Activities%20031717.docx