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May 2022 Round Table Evaluation Form
Contact Information
Name
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First Name
Last Name
Email
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Are you purchasing Continuing Education credits?
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Yes
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Select appropriate Continuing Education Certificate
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Counselor
Nurse
Social Work
Please rate your experience of the Round Table from 5 to 1.
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1 is Very Unsatisfied; 5 is Very Satisfied
select one
5
4
3
2
1
Objectives: Rate the following on a scale of 5 (high) to 1 (low).
At the conclusion of this activity, the learner should be able to:
List 3-4 barriers to a therapeutic relationship with a person with ALS/MND.
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select one
5
4
3
2
1
Describe 3 common demographics of a person with ALS/MND.
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select one
5
4
3
2
1
List 3-4 impacts of ALS/MND may have on communication skills.
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select one
5
4
3
2
1
Describe 3-4 guidelines professionals can use to improve communication.
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select one
5
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1
Detail 3-4 impacts ALS may have CG/PwALS.
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select one
5
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2
1
Detail 3-4 strategies Mental Health Professionals use when working with PwALS & CGs.
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select one
5
4
3
2
1
Rate the following on a scale of 5 (high) to 1 (low).
The session was well organized/interesting delivery.
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select one
5
4
3
2
1
The presenters were knowledgable of the subjects presented.
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select one
5
4
3
2
1
Overall effectiveness of the presenters.
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select one
5
4
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2
1
The information met my expectations for the session.
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select one
5
4
3
2
1
The information was new/useful for me.
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select one
5
4
3
2
1
Overall, this session was beneficial to me.
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select one
5
4
3
2
1
How would you suggest we improve the Round Table for next time?
