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PAPERWORK REDUCTION ACT NOTICE
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FEMA Form 064-0-5
v
Last Reviewed: September 13, 2007
U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727
(301) 447-1000 Fax: (301) 447-1346 Admissions Fax: (301) 447-1441
National Fire Academy Course Evaluation Form
Completion Instructions
1.
Begin by checking the course dates and title below to make sure this is your course.
2.
Use the buttons at the bottom of each page to navigate through the form.
3.
DO NOT enter your name in any location on the form so that your evaluation may remain confidential.
Part 1 of 4 - Course Evaluation Data
Course Dates:
10/25/2010 - 11/05/2010
Course Title:
Executive Leadership
Course Type:
Course Code:
R125
To what extent do you agree with each of the following?
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, N/A=Not Applicable
This Class ...
1
2
3
4
5
N/A
1. Increased my knowledge of this topic.
2. Allowed sufficient time to prepare in and out of class assignments.
3. Was well organized.
4. Challenged me to learn more about this topic.
5. Used effective teaching techniques
(lecture, audiovisuals, scenarios, Web).
6. Had a balance of individual and group-based teaching techniques.
7. Helped me clarify my goals and professional expectations.
8. Provided up-to-date information.
9. Included useful Web/technical resources for the material.
10. Met my expectations.
To what extent do you agree with each of the following?
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, N/A=Not Applicable
The printed materials for this course...
1
2
3
4
5
N/A
1. Were clear and easily readable.
2. Supported class discussion.
3. Will be a useful reference when I get back on the job.
The audiovisual materials for this course...
1. Were of good technical quality.
1
2
3
4
5
N/A
To what extent do you agree with each of the following?
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, N/A=Not Applicable
The computer resources for this course ...
(mark N/A if not applicable)
1
2
3
4
5
N/A
1. Were user friendly.
2. Were available when I needed them.
3. Supplemented other teaching aids used in the course (lecture,
audiovisuals, scenarios, Web)
Have you taken other NFA classes?
On campus
Yes
No
Off campus
Yes
No
To what extent did this course require you to use ...
A lot
Some
None
N/A
Internet and technology resources
NFIRS data
Federal, local, or state resources
GIS data
How might this class be improved?
What was the MOST beneficial aspect of this training class?
What was the LEAST beneficial aspect of this training class?
Before taking this class, was this material ...
-- Please Select --
How do you access information about NFA classes?
(mark all that apply)
USFA/NFA Web page
other students
Other (Specify):
Would you recommend this course to someone?
local departments
information at conferences
Yes
No
Because...
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The Save for Later button will allow you to save answers already provided and come back to the form at a later time (provided the
evaluation period hasn't expired) to complete it.
FEMA Form 064-0-5
Paperwork Reduction Act Notice | OMB No. 1212-0065
Last Reviewed: December 28, 2006
U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727
(301) 447-1000 Fax: (301) 447-1346 Admissions Fax: (301) 447-1441
National Fire Academy Course Evaluation Form
Part 2 of 4 - Course Instructors / Overall Training
Considering the instructors for this course, to what extent do you agree that...
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, NA=Not Applicable
Instructor: John Gallis
1
2
3
4
5
NA
knew the material well.
regularly clarified course and assignment expectations.
encouraged independent thinking from students.
fostered a collaborative "team-based" learning experience.
supplemented course with helpful experience.
answered students' questions clearly.
presented engaging lectures.
led the learning process without dominating it.
exhibited a positive attitude toward students.
conducted the class in a professional manner.
worked well with co-instructor.
is worth recommending to others.
Considering the instructors for this course, to what extent do you agree that...
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, NA=Not Applicable
Instructor: Richard Karlsson
1
2
3
4
5
NA
knew the material well.
regularly clarified course and assignment expectations.
encouraged independent thinking from students.
fostered a collaborative "team-based" learning experience.
supplemented course with helpful experience.
answered students' questions clearly.
presented engaging lectures.
led the learning process without dominating it.
exhibited a positive attitude toward students.
conducted the class in a professional manner.
worked well with co-instructor.
is worth recommending to others.
Is there particular feedback you have regarding the instructors for
this course?
Considering the training overall, to what extent do you agree that this training experience...
1=Strongly disagree, 2=Disagree, 3=Unsure, 4=Agree, 5=Strongly agree, NA=Not Applicable
1
2
3
4
5
NA
will help me do my current job better.
was consistent with my department's training expectations.
will be useful for a department the size of mine.
will be applicable to my future work.
included material helpful to my department's prevention efforts.
will help reduce the fire-related risks in my community.
provided sufficient opportunities for networking.
provided information my department can use when responding to an allhazards and/or terrorist event.
is worth recommending to others.
How satisfied are you with NFA's...
classroom and learning facilities.
Satisfactory
Unsatisfactory
N/A
Learning Resource Center (LRC).
Satisfactory
Unsatisfactory
N/A
dormitory rooms.
Satisfactory
Unsatisfactory
N/A
student center facilities.
Satisfactory
Unsatisfactory
N/A
dining facilities.
Satisfactory
Unsatisfactory
N/A
course registration and administrative details.
Satisfactory
Unsatisfactory
N/A
workout/weight room facilities.
Satisfactory
Unsatisfactory
N/A
Save For Later
Back
Continue
The Save for Later button will allow you to save answers already provided and come back to the form at a later time (provided the
evaluation period hasn't expired) to complete it.
FEMA Form 064-0-5
Paperwork Reduction Act Notice | OMB No. 1212-0065
Last Reviewed: December 28, 2006
U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727
(301) 447-1000 Fax: (301) 447-1346 Admissions Fax: (301) 447-1441
National Fire Academy Course Evaluation Form
Part 3 of 4 - Training Benefits
How do you think this course will help you in your job?
(mark all that apply and note other ways as needed)
General
gave me material I will use daily
showed how to increase my efficiency
will help me use department resources better
gave better idea of Federal, State, local resources
increased my confidence, self-understanding
gave me the big picture, brought me up to speed
gave information for continued learning after training is over
showed value of brainstorming
showed how to use public data sources
showed value of identifying stakeholders
helped to build/increase my professional network
Leadership / Management
provided new people skills
will help me set department goals
will make me a better manager/leader
gave skills for interacting with subordinates
taught me to delegate
identified my leadership style(s)
improved my administrative skills
identified tools for handling departmental conflict
increased my ability to see and set task priorities
showed how to use data (e.g., NFIRS/GIS) for department planning
Technical
provided strategies for handling all-hazards incidents
illustrated use of "recognition-primed" model for decision making
provided new skills in fire protection systems and equipment design and operation
identified skills for managing training
increased my knowledge of health and fire safety issues
identified characteristics of at-risk audiences
provided strategies and techniques for reaching at-risk audiences
increased my knowledge of fire/EMS issues
showed ways to develop interagency cooperation
will help in adapting for small departments and communities
demonstrated the prevention side of EMS
provided information for pre-incident planning
provided tools for incident documentation
Other
How likely are you to re-apply to NFA for future
training?
When considering training, please select how helpful you
find the following.
1=Least helpful, 5=Most helpful
1
Very likely
2
3
4
5
Somewhat likely
Traditional Classroom Training
Not sure/Can't say
Online Training
Not likely to re-apply
Combination of classroom and online
training
Do you plan to use the ACE credit recommendation
associated with this course?
Rate how strongly you PREFER each of the following.
1=Least preferred, 5=Most preferred
1
2
3
4
5
Yes
Self Paced
Somewhat likely
Webinars
No
Online Discussion Board
only
Online Chat Room only
I can't say. I don't know what ACE is.
What are suggested topics for future NFA training classes?
Additional comments?
Save For Later
Back
Continue
The Save for Later button will allow you to save answers already provided and come back to the form at a later time (provided the
evaluation period hasn’t expired) to complete it.
FEMA Form 064-0-5
Paperwork Reduction Act Notice | OMB No. 1212-0065
Last Reviewed: December 28, 2006
U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727
(301) 447-1000 Fax: (301) 447-1346 Admissions Fax: (301) 447-1441
National Fire Academy Course Evaluation Form
Part 4 of 4 - Student and Department Demographics
Department/ Organization location:
Are you attending course as...
-- Please Select -
Career
Volunteer
Other
Your Fire Department Identification Number (FDID)
(Fire Department Personnel Only):
Search for FDID
Years of experience in subject area related to course:
-- Please Select --
Population currently served by your organization:
-- Please Select --
Level of formal education:
-- Please Select --
Are you a fire instructor in your local jurisdiction?
yes
no
-- Please Select -What is your present position?
If Other, please specify:
-- Please Select -What is your primary responsibility?
If Other, please specify:
How long have you been in fire and emergency services?
-- Please Select --
What percent of your department are volunteer personnel?
-- Please Select --
Are you:
How old were you on your last birthday?
male
female
prefer not to answer
0
Hispanic or Latino/Latina
Please mark the ethnicity that best applies to you:
Not Hispanic or Latino/Latina
Prefer not to answer
American Indian or Alaska Native
Asian
Are you one or more of the following:
Black or African American
Native Hawaiian or Pacific Islander
White
Save For Later
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Submit Evaluation
The Save for Later button will allow you to save answers already provided and come back to the form at a later time (provided the
evaluation period hasn’t expired) to complete it.
FEMA Form 064-0-5
Paperwork Reduction Act Notice | OMB No. 1212-0065
Last Reviewed: December 28, 2006
U.S. Fire Administration, 16825 S. Seton Ave., Emmitsburg, MD 21727
(301) 447-1000 Fax: (301) 447-1346 Admissions Fax: (301) 447-1441
| File Type | application/pdf |
| File Title | http://166.112.27.14/applications/nfaeval/ce/login.do |
| Author | dlong2 |
| File Modified | 2010-10-28 |
| File Created | 2010-10-28 |