Free Wisconsin Public Psychiatry Network Teleconference Evaluation, DDE-2642 - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Mental Health and Substance Abuse Services F-22642 (07/2008)

STATE OF WISCONSIN

WISCONSIN PUBLIC PSYCHIATRY NETWORK TELECONFERENCE EVALUATION
Complete and return one form for each participant for each teleconference. NOTE: Every person requesting CEUs MUST register with the WisLine on-line registration http://www.uwex.edu/ics/wlreg/wlwelcome.cfm (608) 262-0753 (voice) and include complete agency name (no abbreviation) and complete address in order to receive certificates. CEU certificates for January ­ June are sent in late August and certificates for July ­ December are sent in late February. Submit evaluations promptly and mark the date of the actual teleconference on the form. Name: Address ­ Agency: Date: Topic: Name ­ Presenter: Check the number that most closely reflects your assessment of each presentation. Poor Excellent Format of presentation 1 2 3 4 5 Presentation of useful ideas 1 2 3 4 5 Importance of topic 1 2 3 4 5 Quality of presenter 1 2 3 4 5 Presentation length 1 2 3 4 5 Check the response that applies to you and your site. The phone I use has a mute feature My phone's mute is kept ON during the teleconference If I ask a question, I put the mute back ON to listen Comments on presentation: Yes Yes Yes No No No (mm/dd/yyyy)

Additional Comments on Overall Quality of Teleconference Most helpful or relevant:

Least helpful or relevant:

Recommendations (include speakers and topics)

Return to:

Bureau of Prevention, Treatment and Recovery, 1 W. Wilson, Box 7851, Madison, WI 53707-7851 FAX number: (608) 267-9392 Telephone number: (608) 267-7792 (voice)

To purchase a teleconference audiotape or CD, give the date of the teleconference, identify it as a WisLine mental health teleconference code 1099 and send a check for $9.00 for audiotape and $15.00 for CD to UW Extension, c/o Donna Kozuscek, UWEX/ICS, Pyle Center, 702 Langdon Street, Madison, WI 53706-1391 or call (608) 262-4342 (voice).