MSOA Participant Evaluation Form OMB

Module 12: Older Adults

Instructor Guide

What Do You Know? – Money Smart for Older
Adults
Instructor: ___________________________________ Date: ____________________
This form will allow you and the instructors to see what you know about protecting your
finances both before and after the training. Read each statement below. Please circle the number
that shows how much you agree with each statement.
Before the Training
I am able to:
1. Recognize elder financial exploitation.
2. Guard against identity theft.
3. Plan for unexpected loss of the ability to manage
my finances.
4. Prepare financially for disasters.

5. Find other helpful resources for managing my
money.

After the Training
I am able to:
6. Recognize elder financial exploitation.
7. Guard against identity theft.
8. Plan for unexpected loss of the ability to manage
my finances.
9. Prepare financially for disasters.

10. Find other helpful resources for managing my
money.

Money Smart for Adults

OMB No. 3170-0024 (Expiration Date: XX/XX/XXXX)

Strongly
Disagree

Disagree

Agree

Strongly
Agree

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2

3

4

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4

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4

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4

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4

Strongly
Disagree

Disagree

Agree

Strongly
Agree

1

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4

1

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4

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4

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Module 12: Older Adults

Instructor Guide

Evaluation Form
This evaluation will enable you to assess your observations of the Money Smart for Older Adults
module. Please indicate the degree to which you agree with each statement by circling the
appropriate number.
Overall, I felt the module was:
[ ] Excellent
[ ] Very Good
[ ] Good
[ ] Fair
[ ] Poor
Strongly
Disagree

Disagree

Agree

Strongly
Agree

1. I achieved the training objectives.

1

2

3

4

2. The instructions were clear and easy to
follow.

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3

4

3. The slides were clear.

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4

4. The slides enhanced my learning.

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3

4

5. The time allocation was correct for this
module.

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4

6. The module included sufficient examples
and exercises so that I will be able to apply
these new skills.

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4

7. The instructor was knowledgeable and
well-prepared.

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4

8. The worksheets are valuable.

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4

9. I will use the worksheets again.

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10. The participants had ample opportunity to
exchange experiences and ideas.

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4

11. I had knowledge of the subject matter
before taking the module.

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2

3

4

Money Smart for Adults

OMB No. 3170-0024 (Expiration Date: XX/XX/XXXX)

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Module 12: Older Adults

Instructor Guide

12. I have knowledge of the subject matter
upon completion of the module.

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2

3

4

13. Name of Instructor:________________
Strongly
Disagree

Disagree

Agree

Strongly
Agree

Objectives were clear & attainable

1

2

3

4

Made the subject understandable

1

2

3

4

Encouraged questions

1

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4

Had technical knowledge

1

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3

4

Please use the response scale and circle the
appropriate number.

What was the most useful part of the training?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What was the least useful part of the training and how could it be improved?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Privacy Act Statement
5 U.S.C. 552a(e)(3) The information you provide to the Consumer Financial Protection Bureau (“CFPB”) will only be used to evaluate the
Money Smart for Older Americans Training Sessions. The Bureau may obtain or access directly identifying information about participants.
Information collected will be treated in accordance with the System of Records Notice (“SORN”), CFPB.021 – CFPB Consumer Education and
Engagement Records, 83 FR 23435. Although the Bureau does not anticipate further disclosing the information provided, it may be disclosed as
indicated in the Routine Uses described in the SORN. Direct identifying information will only be used to facilitate the training and will be kept
private except as required by law. This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified
at 12 U.S.C. §§ 5493 and 5512. Participation in this evaluation is voluntary. You are not required to participate or share any identifying
information and you may withdraw participation at any time. However, if you do not include the requested information, you may not be able to
participate in the evaluation.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding any other provision of law a
person is not required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number for this
collection is 3170-0024. It expires on XX/XX/XXXX. The time required to complete this information collection is estimated to average
approximately 5 minutes per response. Comments regarding this collection of information, including the estimated response time, suggestions
for improving the usefulness of the information, or suggestions for reducing the burden to respond to this collection should be submitted to
Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email to
[email protected].
Money Smart for Adults

OMB No. 3170-0024 (Expiration Date: XX/XX/XXXX)

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