The University of Massachusetts

Labor Extension Program

Please fill out and send in one of these forms when you use the curriculum, so that we can make improvements in future versions.

If you have any questions, contact Tess Ewing by email or phone (617-287-7352)

Your name:

Number and description of participants:

How many modules did you do?

If more than one, how was it done? (i.e. in a series, 2 or more free standing sessions, the complete series, etc.)

Facilitators’ Introduction

	Very Well				Not At All
How well did it work?	1	2	3	4	5

Suggestions for improvement:

If the entire curriculum was done:

	Very Well				Not At All
How well did it work?	1	2	3	4	5

What was missing?

Other comments or suggestions:

Please complete the following for each Module done:

Module Number and Name:

	Very Clear				Not At All
How clear was the Facilitators Outline?	1	2	3	4	5

Suggestions for improvement:

	Very Much				Not At All
Were the objectives the right objectives?	1	2	3	4	5
How well did activities address objectives?	1	2	3	4	5
	Very				Not At All
How effective were activities in engaging participants?	1	2	3	4	5
How appropriate were the times for each activity?	1	2	3	4	5
How appropriate was literacy level for your group?	1	2	3	4	5

What worked well?

What was missing?

What suggestions for improvement?

Please sum up key points about the curriculum from the participants evaluation:

Any additional comments: