ACTIVITY EVALUATION FORM

Provider: Smartsettle Division of ICAN Systems Inc.
Phone: 604-852-6941, Fax: 604-852-0909
Canada: PO Box 8000 # 611, Abbotsford, BC V2S 6H1
USA: PO Box 8000 # 611, Sumas WA 98295 – 8000

Please print, complete with clear printing, sign this form and fax to Smartsettle.

Title of Activity: Smartsettle Facilitator Training Level (s)_________ (I - V)

Participation beginning date: _________________________

Participation completion date: _________________________

Name of Participant (optional): _______________________________________

On a scale of 1-5 (5 being the highest, best or most and 1 being the least, lowest or worst) rate by circling the number reflecting your opinion.

To what extent were your personal objectives satisfied?                                                            

5  4  3  2  1       Comments: _______________________________________________

_____________________________________________________________________     

To what extent did the environment contribute to the learning experience?

5  4  3  2  1       Comments: _______________________________________________

_____________________________________________________________________     

To what extent did the written materials contribute to the learning experience?

5  4  3  2  1       Comments: _______________________________________________

_____________________________________________________________________     

To what extent were the objectives stated in the promotional literature or those stated at the beginning of the activity satisfied?

5  4  3  2  1       Comments: _______________________________________________

_____________________________________________________________________     

To what extent did the activity contain significant current intellectual or practical content?

5  4  3  2  1       Comments: _______________________________________________

_____________________________________________________________________     

Please rate the instructors on the same scale described above and add any comments in the space provided.

Instructor’s Name

What s/he taught

Overall Teaching Effectiveness

Effectiveness of Teaching Methods

Significant Current Intellectual of Practical Content

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1

5  4  3  2  1