Great Lakes Trainers Harvard Minute Feedback

Form Approved
OMB No. XXXX-XXXX
Exp. Date xx/xx/xxxx

[Training Title]
[Training Date]

E18. “Harvard Minute” Feedback Form

Please take about a minute to record your responses to the following
three questions. You do NOT need to provide your name.
What would you like to learn more about?

What question(s) do you still have?

How can we make tomorrow better?

The public reporting burden of this collection of information is estimated to average 1 minute per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection 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 - CDC/ATSDR Reports Clearance Officer; 1600 Clifton
Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (XXXX-XXXX)