Pacific Crest Workshop Assessment Form

Please take a few minutes to share your assessment of the recent event you attended.

Name Date
Institution Workshop Name
Department Position
Email Address Phone Number

May we e-mail you our quarterly newsletter, Reflections? (you may unsubscribe at any time)

Yes   No

May we e-mail you a FREE bi-weekly Insight? (you may unsubscribe at any time)

Yes   No

May we share your comments about this event with others?

Yes   No 

Feedback about the Workshop

   Use the sliders to rate the following:

Degree to which your expectations were met

not met at all some were met most were met met all expectations beat my expectations  


Your level of interest in the content presented/covered

no interest at all low medium high extremely high  


Quality of the materials
used for the workshop

very low quality low quality neutral good quality very high quality  


Interest in participating in future institutes/workshops

no interest at all low I'll think about it high extremely high  


Effectiveness of the

not effective at all slightly effective somewhat effective effective extremely effective  


Assess the workshop using the SII Method:

3 Strengths of the workshop:

3 Areas for Improvement

Any Insights or ideas that
resulted from the workshop:

Please share how what you have learned today will influence your teaching:

Additional comments or feedback