Qualtrics Survey | Qualtrics Experience Management

If you are a clinical instructor (CI) for Washington University, you may apply to receive a certificate of attendance that may be submitted for continuing education units (CEUs). To receive your certificate, please complete the following survey. Upon verification of clinical instructor status, the certificate of attendance will be provided. Certificates will be e-mailed to attendees quarterly. Washington University cannot guarantee the CEUs earned by viewing this webinar will be approved by the attendee's state regulatory body.

Participant Full Name

Participant E-mail Address

Participant Place of Employment

Date of Presentation

Name of Presentation File Viewed

Please rate the following:

Please rate the following:
	Excellent	Good	Average	Poor	Terrible
Understandability of Presentation/Presentor	Excellent	Good	Average	Poor	Terrible
Usefulness of Information Presented	Excellent	Good	Average	Poor	Terrible

The information provided me with (select all that apply)

evidence for clinical care
basic science information
interest in developing a clinical trial
information to use in teaching students
information to use in teaching clinicians
interest in learning more
Other, please explain:

Additional Feedback:

Additional Feedback:
	Excellent	Good	Average	Poor	Terrible
Organization	Excellent	Good	Average	Poor	Terrible
A/V Quality	Excellent	Good	Average	Poor	Terrible

Please rate the following:

Please rate the following:
	too fast	just right	too slow
Lecture Pace was	too fast	just right	too slow

Please rate the following:

Please rate the following:
	interesting	not interesting	too techinical
Content was	interesting	not interesting	too techinical

What did you like/dislike about the lecture?

Suggestions for future talks related to this topic (optional):