Form 0917-0036-05 OMB Form No. 0917-05, FY_ Classroom Post Class Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB Form No. 0917-0036- 05, FY_ Classroom

Classroom Post Class Survey

OMB: 0917-0036

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REQUIRED OMB INFORMATION: 
Indian Health Service (IHS) FY_ Classroom Post Class Survey  
 
Form Approved 
OMB Form No. 0917­0036­05 
Expiration Date: 5/31/2015 
 
According to the Paperwork Reduction Act of 1995, no persons are 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 0917­0036. 
The time required to complete this information collection is estimated to average 5 minutes per response, including the 
time to review instructions, search existing data resources, gather the data needed, and complete and review the 
information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for 
improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence 
Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer. 

OIT values your input on the course you have just completed. Comments included on this post class survey will be used 
to help improve the effectiveness of OIT's training program. 

*1. How did you hear about this OIT sponsored RPMS course?
c Web Site
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c Other (please specify)
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*2. Was the registration process easy?
 

j Yes
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j No
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If you answered no, please identify ways to make the registration process easier. 

*3. Please rate the facility components below.
The presentation 

Strongly Disagree

Disagree

Somewhat Agree

Agree

Stongly Agree

N/A

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equipment/computers 
functioned properly.
The room was a 
comfortable learning 
environment.
Local IT support was 
responsive to class needs.

*4. Is there anything that would improve this training center?
j No
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j Yes
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If yes, please note how this training center may be improved: 

*5. Please rate the presentation materials and methods.
Strongly 
Disagree

Disagree

Somewhat Agree

Agree

Strongly Agree

Materials were clear and easy to follow.

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The printed materials were valuable.

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The electronic materials were valuable.

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Objectives were clearly stated at the beginning of the 

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Training was paced appropriately.

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Sufficient practice time was provided.

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The hands­on exercises enhanced the learning 

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session.

experience.
The hands­on exercises were useful in reinforcing the 
course objectives.

*6. Please rate the instructor.
Strongly 
Disagree

Disagree

Somewhat Agree

Agree

Stongly Agree

Arrived prepared and organized.

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Explained objectives clearly at the start of the training.

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Demonstrated knowledge of the subject material.

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Provided useful feedback on performance throughout the 

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Provided clear instructions.

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Addressed participant questions.

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Made the course interesting.

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session.

*7. What part of the training did you find most useful?
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*8. What part of this training did you find least useful?
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9. Please make additional comments here.
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