Free Wisconsin Public Psychiatry Network Teleconference Evaluation - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Mental Health and Substance Abuse Services F-21283 (09/2008)

STATE OF WISCONSIN

WISCONSIN PUBLIC PSYCHIATRY NETWORK TELECONFERENCE EVALUATION
Completion of this form is voluntary. Failure to complete this form will result in the respondent not receiving credit for participation in the teleconference. Please submit one form for each participant for each teleconference. In order to receive credit you will need to have the survey returned within two weeks of the teleconference. Please note that each site must register for each teleconference with the Wisline online registration at http://www.uwex.edu/ics/wlreg/wl_welcom.cfm Please enter information on the presentation for which you have participated. 1. 3. 4. 6. 8. 9. Date of Presentation Name - Presenter Name ­ Respondent (Last) Position ­ Respondent (Optional) Ethnicity ­ Respondent (Optional) Asian Black Hispanic Native American White Other--specify: 5. 7. Name ­ Respondent (First) Gender ­ Respondent (Optional) Female Male 2. Presentation Topic

_______________

Agency (Optional)

10. Address ­ Respondent (Mailing: Street or PO Box) 11. City 14. Email Address - Respondent 12. State 13. Zip Code

For items 15 ­ 19, please check the answer that most closely reflects your assessment of this presentation
15. Importance of Topic Excellent 16 Quality of Presentation Excellent 17. Quality of Materials Excellent Good Good Good Fair Fair Fair Disagree Disagree Poor Poor Poor Strongly Disagree Strongly Disagree Not Applicable

18 I expect this training to benefit consumers Strongly Agree Agree 19 I expect to use the information gained from this training Strongly Agree Agree

20. Additional Comments (what was most useful or were areas that need improvement)

21. Suggestions for future teleconferences Topics: Speakers: Contact Information: Kay Cram, MS, LPC, Division of Mental Health and Substance Abuse Services, 1 W. Wilson, Box 7851, Madison, WI 53707-7851, Telephone (608) 261-6743 (voice), FAX (608) 266-1533, email: [email protected] Teleconference Website: http://dhs.wisconsin.gov/mh_bcmh/confandtraining/Teleconferencesch.htm