FSA-2376 Borrower training course evaluation

Form Approved - OMB No. 0560-XXXX

This form is available electronically.
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2376
(Proposal 3)

Position 3

BORROWER TRAINING COURSE EVALUATION
PART A - TO BE COMPLETED BY VENDOR
1. Course Title

2. Instructor's Name

3. Vendor's Name

4. Vendor's Address

5. Dates of Training Course

6. Location

PART B - TO BE COMPLETED BY BORROWER
11. Comments on the strong points of the course:
1. The topics covered in class were
helpful to me in my business...............

Yes

Partially

No

2. The coverage of the subject matter
was........................................................

Excellent

Sufficient

Poor

3. The suitability of the instruction
material was.........................................

Excellent

Sufficient

Poor

4. The level of the course was.................

Too
Advanced

Appropriate

Too
Easy

5. The length of the course was ..........

Too Long

Appropriate

Too
Short

6. The amount of outside work was.........

Too Much

Appropriate

Too
Little

7. The instructor was...............................

Excellent

Good

Poor

8. The facilities were. ............................

Excellent

Good

Poor

9. Will you continue to take training
courses in production and financial
management if not required?.............

Yes

Maybe

No

10. Would you recommend this course
to other individuals? .........................

Yes

No
Comment

No

12. Comments on the weak points of the course:

13(a). Signature: (Optional)

13(b). Date

After you have completed this evaluation, please return it to the Vendor.
NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated Farm and Rural Development Act, as
amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its application forms. The information requested is necessary for FSA
to determine eligibility for credit or other financial assistance, service your loan, and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies,
the Internal Revenue Service, the Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor,
the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of
Information Act , to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit reporting agencies,
to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or
Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including
Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0560-XXXX. The time required to complete this information collection is estimated to average 23 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. VENDOR SHALL
RETURN THIS COMPLETED FORM TO THE FSA OFFICE.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial
status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited
bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at
(202) 720-2600 (voice and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272
(voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.