Shout at Cancer Feedback Form
Course: ………………………….…………...……………..…… Date: .…………..……………..…
Teacher’s Name: …………….……………..… Participant Name:(optional)………...….….........….…….
Please answer the questions below as truthfully as possible to help us improve our courses and develop our company. Circle the number that best describes your feeling about each question:
At enrolment, did you receive all the information needed to make a satisfactory choice about the
program?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were you given a clear idea of what you would gain by the end of the program?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Was the content what you expected?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Did the content meet your needs?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Did you think that the teacher had good knowledge of the topics they were teaching?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Did the teacher present the information clearly?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Was the teacher well prepared?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were your questions answered well?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Was the pace suitable for you needs?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were you satisfied with the learning materials?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Was the equipment adequate?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Did you find the facilities suitable?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were you actively involved in your group?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were you given the learning support you felt you needed as an individual?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Were any special needs you had met?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
Did you feel that your cultural or linguistic background was fully incorporated in the learning?
1 - never, 2 – rarely, 3 – sometimes, 4 – mostly, 5 – always
On a scale of 1 to 10 how do you rate your overall satisfaction with this program?
1 2 3 4 5 6 7 8 9 10
If you were dissatisfied with any aspect please comment further:
How could this program be improved?
We are particularly interested in your views on whether we are meeting our mission to train patients and speech therapists to develop meaningful, culturally diverse tracheoesophageal voice rehabilitation.
Are there any other comments you would like to make?
Please feel free to speak in confidence with staff (or your trainer) about any aspects of the program. If you would like staff to contact you to discuss any issues, please provide your contact number. Phone:
Thank you for taking the time to complete this evaluation.