Form FEMA Form 092-0-2A FEMA Form 092-0-2A Level 3 Evaluation Form for Students

Center for Domestic Preparedness (CDP) Level 3 Evaluation Form for Students
OMB No: 1660-xxxx
FEMA Form 092-0-02A
Expiration:

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Part 1 of 2 - Please Tell Us About Your Background and Place of Work
Course Dates:
Course Title:
Course Code:

1. How many CDP on-campus resident courses have you taken during your career?

2. How many CDP off-campus courses have you taken during your career?

3. How would you describe the primary population served by your department or organization? (Mark all that apply.)
Urban

Statewide

Non-Governmental Organization

Suburban

County/District

Institutional

Rural

Parish

Private Sector

Tribal

Government

Other

If Other, please specify

4. How many years have you been in your present position?
If you are currently retired, indicate the years of service prior to your retirement. Select

5. Please indicate your present primary discipline.

Select

If Other, please specify

6. What is the highest level of education you have achieved?
If Other, please specify

Please continue on the next page

Select

Center for Domestic Preparedness (CDP) Level 3 Evaluation Form for Students
Part 2 of 2 - Course Feedback

1. Why did you take this course? (Mark all that apply.)
Supervisor recommended it.
Attendance required for my next duty or assignment.
For general career advancement.

Desire to broaden my perspective by working with personnel from departments across the country.
Desire to increase my technical and professional knowledge.
Other
If Other, please specify
2. Have you used any of the concepts or skills gained of this training on the job since returning to your department?
Yes

No

3. Indicate your level of agreement or disagreement with each statement by selecting the appropriate value.
Strongly
Agree

Agree

Neutral

Disagree

a. What I learned from this course helped me do my job better.

b. This course has contributed to my professional development.
My supervisor is aware of how this
c. course has improved my job performance.
d. training has helped the department address problems in our
community's high-risk areas.
This CDP training has
e. assisted me in identifying the risk and threats that I may face
in my work.
f. made me more safety conscious in my work.
Concepts and skills gained from the course have
g. been incorporated into the staff development efforts of my
department.
h. improved the performance of my department.
This training has helped my
i. department be better prepared to respond to an all hazards
or terrorist event.

4. Would you recommend this course to others in your department?

Select

5. Have you attended other (non-CDP) courses covering the same subject matter in the last three years?
Yes

No

Please continue on the next page

Strongly
Disagree

Not
Applicable

Center for Domestic Preparedness (CDP) Level 3 Evaluation Form for Students
Part 2 of 2 - Course Feedback (continued)

6. Please describe an incident or circumstance in which you applied your training from this CDP course, if applicable.

7. If you could change one thing to improve this training course, what would it be?

8. Please tell us what you think are emerging issues that should be considered as topics for future CDP courses.

9. Please add any comments you may have.

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FEMA Form 092-0-2A