FNS 817 Level III Feedback Form

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

Level III Event Feedback Form
1) Before participating in the event, how would you define your level of knowledge in the subject area?
Very Knowledgeable
Knowledgeable
Somewhat Knowledgeable
No Knowledge
2) After participating in the event, how would you define your level of knowledge in the subject area?
Very Knowledgeable
Knowledgeable
Somewhat Knowledgeable
No Knowledge
3) Following the event, were you able to apply any newly acquired skills, knowledge, or attitudes to your everyday
environment? Is so, how? If not, please explain.

4) Has your organization done anything differently as it relates to the topic? If so, how? If not, please explain.

5) What obstacles make it difficult to apply newly acquired skills, knowledge, or attitudes?

6) To what extent do you either plan to continue to use, or begin to use your new skills, knowledge or attitudes in the
future?

7) What resources and information from the event have you been able to use or reference?
Brochures/Flyers
Note from Session
Presentation Handouts
Presentation Slides
Reference Materials
Resource CDs
Webcast Link
Website
Other (please specify)
If you selected other, please specify:

FORM FNS-817 (04/10) Previous Editions are Obsolete

SBU

Electronic Form Version Designed in Adobe 8.1 version

8) What resources and information from the event have you been able to share with others?
Brochures/Flyers
Notes from Session
Presentation Handouts
Presentation Slides
Reference Materials
Resource CDs
Webcast Link
Website
Other (please specify)
If you selected other, please specify:

9) What additional information or materials would be useful to you or your organization?

10) What topics would you like to be covered in future events?

11) Other comments:

Public reporting burden for this collection of information is estimated to average 10 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.