Form FEMA Form 95-96 FEMA Form 95-96 Follow-Up Evaluation Survey

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

FOLLOW-UP EVALUATION SURVEY

EMERGENCY MANAGEMENT
INSTITUTE

O.M.B. NO. 1660-0044
Expires June 30, 2008

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 15 minutes per response. Burden means the time, effort and financial
resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding
the burden estimate or any other aspect of the form, including suggestions for reducing the burden to: Information Collections Management,
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC20472, and Paperwork
Reduction Project (1660-0273). You are not required to respond to this collection of information unless it displays a valid OMB control
number. NOTE: Do not send your completed form to the above address.
COURSE TITLE AND NUMBER

COURSE DATE

STATE

Have you been able to apply the training received in tis EMI course in your job or work assisgment? Check one.
Yes (Please go to block 1)

No (Please go to block 2)

Block 1 - If you answered "Yes", how did you use the EMI training? Plsease describe any direct benefits to your agency or community?

Block 2 - If no, Could any difference in the course materials or instruction have made the course more useful?

Please use the enclosed envelope to return this survey by
Thank You.
FEMA Form 95-56, JUN 05

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