FSA-2376 Borrower training course evaluation

This form is available electronically. Form Approved – OMB No. 0560-0237

FSA-2376 U.S. DEPARTMENT OF AGRICULTURE (12-31-07) Farm Service Agency BORROWER TRAINING COURSE EVALUATION
PART A – TO BE COMPLETED BY VENDOR
1. Course Title      						2. Instructor’s Name      
3. Vendor’s Name      						4. Vendor’s Address      
5. Date of Training Course      						6. Location      
PART B – TO BE COMPLETED BY BORROWER
1. The topics covered in class were helpful to me in my business………		Yes	 	Partially	 		No	 	11. Comments on the strong points of the course:      
2. The coverage of this subject matter was……………………………..…..…		Excellent	 	Sufficient	 		Poor	 
3. The suitability of the instruction material was…………..……...…….….		Excellent	 	Sufficient	 		Poor	 
4. The level of the course was……….….		Too Advanced	 	Appropriate	 		Too Easy	 
5. The length of the course was………..		Too Long	 	Appropriate	 		Too Short	 
6. The amount of outside work was……..		Too Much	 	Appropriate	 		Too Little	 	12. Comments on the weak points of the course:      
7. The instructor was………………..…..		Excellent	 	Good	 		Poor	 
8. The facilities were…………..……….…		Excellent	 	Good	 		Poor	 
9. Will you continue to take training Courses in production and financial management if not required?..............		Yes	 	Maybe	 		No	 
10. Would you recommend this course to other individuals?.............		Yes	 	No Comment	 		No	 
13(a). Signature (Optional)										13(b). Date      
After you have completed this evaluation, please it to the Vendor.
NOTE:	The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated Farm and Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan, and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including your Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0560-0237. The time required to complete this information collection is estimated to average 30 minutes 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. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

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