<p> CME Evaluation Form Example Name of Course Location of Course Date of Course Sponsored by the Public Health Consortium Presented by ______</p><p>Plenary Sessions ______CME Hours Time: Program: Presenter Brief course description Presenter Brief course description Presenter Brief course description Q and A BREAK Presenter Brief course description Presenter Brief course description Presenter Brief course description Q and A ______Objectives: [Statement of objectives] The attendee should come away with an understanding of ______</p><p>Evaluation – Please circle the number which most closely represents your view on each of the following. 1. The presentation met the program objectives (above) Poor 1 2 3 4 5 6 7 Excellent 2. The quality of the speakers Poor 1 2 3 4 5 6 7 Excellent 3. Effectiveness of the written handouts/materials Poor 1 2 3 4 5 6 7 Excellent 4. Practical value of the subject matter to me Poor 1 2 3 4 5 6 7 Excellent 5. Value of the program in a public health setting Poor 1 2 3 4 5 6 7 Excellent 6. I have the following recommendations for improvement of the program: ______7. I would suggest the following topics for future symposia: ______8. Information presented at course will help me improve: ______9. The material presented will be incorporated in my practice in the following way: ______10. My overall impression of the program Poor 1 2 3 4 5 6 7 Excellent</p>