FNS 816 Level I Feedback

Form Approved OMB NO. 0584-XXXX
Expiration Date: XX/XX/XXXX

Level I Event Feedback Form
1) How did you participate?
In person
Online (webinar)
2) Did this event help you acquire useful information?
Yes
No
Unsure
3) Did the information provided in this event meet your expectations?
Yes
No
Unsure
4) Base on your experience with this event, would you participate in another event with similar format?
Yes
No
Unsure
5) Would you be interested in participating in another event in a related subject area?
Yes
No
Unsure
6) The following refer to your level of satisfaction with the event.
Very
Satisfied

Satisfied

Quality of
the overall
event

Neither
Satisfied or
Dissatisfied

Dissatisfied

Very
Dissatisfied

Does
Not
Apply

Scope of the
information
Usefulness of
the
information
Presenter(s)/
facilitator(s)
Materials

FORM FNS-816 (04/10) Previous Editions are Obsolete

SBU

Electronic Form Version Designed in Adobe 8.1 version

Comments:
7) How do you plan to share the information obtained during the event?
Email Information
Giving a Presentation
Holding a Debrief Meeting
Posting Information Online
Post Paper Handouts/Materials
Professional Development
Providing a Link to Webinar Recording
Sharing Handouts/Materials Elecronically
Sharing Paper Handouts/Materials
Starting a Workgroups/Committee
Writing a Summary to Distribute
Word of Mouth
Unsure
Other, please specify
Comments:
8) Did this event change your thinking or knowledge about the topic? If so, how? If not, please elaborate.
9) Do you think you or your organization will do anything differently as it relates to the topic? If so, how? If not, please
elaborate.
10) Please provide any feedback regarding the event's strengths.
11) Please provide any feedback regarding the event's areas for improvement.
12) What topics would you like to be covered in future events?
13) What additional information or materials would be useful to you or your organization?
14) Other comments:

15) Would you like to be added to a distribution list/listserv to received additional information from FNS in the future?
No
Unsure
Yes, If you selected "Yes" please provide your email address:
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collections of information. An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of
Research and Analysis, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-0524). Do not return the completed form to this address.