C Attachment C - All Grantee Meeting Assessment Form Indiv

OMB Control No. 0915-0212

Expiration Date: 05/31/2018

2016 MIECHV All Grantee Meeting

June 8 -10, 2016

Individual Session Feedback Form

Please select your affiliation

☐ MIECHV State Region or Territory

☐ Tribal Home Visiting Program

☐ Other

Please select the role that most closely aligns with your responsibilities related to the MIECHV project.

Grantee Lead/Director/Coordinator Grantee Data/Evaluation Staff Grantee Program Staff/Consultant Grantee Grants Management/Fiscal Staff Home Visitor ECCS Coordinator/Staff

Federal Staff/Partner Model Developer National TA Provider Speaker Other

Please rate each session using the scale listed below

Not at all Somewhat Very much

Very little Quite a bit

Please indicate the degree (enter rating 1, 2, 3, 4 or 5 in the box) to which the Plenary or Breakout session...	Achieved intended objectives	Met your needs	Provided new information	Allotted time for questions and and/or quality discussion	Was well organized, engaging and effectively presented	Speaker(s) demonstrated topic expertise	Provided information you can apply to practice and/or enhanced your professional expertise
Plenary: Date, title and presenter
Breakout Session: Date, title & presenter

What is one thing that you like best about the session:

What is one thing that you would change:

Other comments: