Student Name (required)

Student Email (required)

Title: Doctor / Physical Therapist (required)

Name of Course (required)

Instructors Name (required)

Date Course Was Taken

Date

Month Day Year
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PLEASE RATE US ON A SCALE OF 1-5 WITH 5 INDICATING EXCELLENT AND 1 POOR

SELECT THE NUMBER YOU FEEL MOST APPROPRIATE

Course Offering

Please Select The Appropriate Rating:

1. Course Content Met Your Needs:

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2. Course Matched Description that was advertised:

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3. Pace of the Class:

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4. Textbook/Materials/Handouts:

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5. Class Location & Equipment:

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Comments? (Please elaborate)

The Instructor

Please Select The Appropriate Rating:

1. Knowledge of the Subject Matter:

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2. Preparation for Each Class:

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3. Communicated Material Effectively:

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4. Responded Well to Student Questions:

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5. Established Positive Rapport With Students:

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Comments? (Please elaborate)

Additional Questions

What did you find was the most valuable part of this course?

Do you have any suggestions on how we could improve this program?

Other comments?