Contraceptive Technology and Reproductive Health Series

Online Evaluation Form

After completing all 12 modules, you are eligible to receive a certificate of completion. You must submit an evaluation form in order to receive the certificate. If you have submitted an evaluation form before completing all 12 modules, please let us know in writing once you have finished all of the modules and we will send you a certificate. Please be sure to complete each post-test and review any wrong answers. Thank you for your feedback!

We would appreciate your help in evaluating the Contraceptive Technology and Reproductive Health Series modules. Please answer the questions below after completing the training on the modules. The information you provide will help Family Health International (FHI) improve future training presentations. If you have completed all of the modules, please mark each module in Question 2, and FHI will send you a certificate of completion.

If you prefer, a printable evaluation form is available by clicking the link below the form.

Please fill in all appropriate blanks. Type "N/A" where information in not available. The asterick symbol (*) denotes fields where information is required.

NOTE: The information you provide in this questionnaire will NOT be shared outside FHI or for commercial use.

Last Name:*

First Name:*

E-mail Address:*

Position Title:*

Department:

Organization:*

Mailing Address:

Address (cont.):

City:*

State/Province:

Postal Code:

Country:*

Telephone:

Fax:

1. What are your current job responsibilities? (Please mark all that apply.)
Policymaker
Program manager
Practicing doctor
Practicing nurse
Practicing midwife
Nonmedical clinical personnel
Community health worker
Medical faculty
Student (medical, nursing, midwifery)
Health educator
Pharmacist
Other (specify)

2. Which modules did you complete: (Please mark each module that you finished.)
Introduction to Contraceptive Methods
Barrier Methods
Client-Provider Interaction
Emergency Contraceptive Pills
Injectable Contraceptives
Intrauterine Devices (IUDs)
Lactational Amenorrhea Method (LAM)
Oral Contraceptives
Reproductive Health of Young Adults
Sexually Transmitted Diseases
Female and Male Sterilization

3. Was the Web site easy to navigate? Yes No

4. Was the format of the Web site conducive to learning the information in the
modules? Yes No

5. How familiar were you with the information in the modules prior to viewing them?
Very familiar Somewhat familiar Not at all familiar

6. Which two modules do you think will be the most useful to you?

1.
2.

7. What information, if any, should have been covered but was not included?
(Please specify.)

8. How did you benefit from the modules? (Please mark all that apply.)
Learned more about each contraceptive method.
Gained a new perspective on providing reproductive health care to adolescents.
Learned more about sexually transmitted diseases.
Improved understanding of the content throught learner activities.
Reinforced the material that was learned after completing the post-test for
each module.
Gained a broader outlook on reproductive health as a whole.
Did not benefit.
Other (specify)

Please repond to each of the following statements by marking the choice that best describes your feelings.

9. The information presented was relevant to my job.
Strongly agree Agree Disagree Strongly disagree

10. The graphics and other visual aids enhanced my understanding of the presentation
content.
Strongly agree Agree Disagree Strongly disagree

11. The learner activities enhanced my understanding of the presentation content.
Strongly agree Agree Disagree Strongly disagree

12. The duration of the module presentations was appropriate.
Strongly agree Agree Disagree Strongly disagree

Please rate the following presentation components.

	EXCELLENT	GOOD	FAIR	POOR	NON-APPLICABLE
Contents
Articles/references
Learner activities
Post-test
Other (Specify)

Would you recommend this product to colleagues? Yes No

Why or why not?

Please add any additional comments or suggestions.

Thank you for your assistance. Please submit the form.

If you prefer, click on the link below to view a printable evaluation form. You may send a completed form to FHI after working on any of the Contraceptive Technology and Reproductive Health Series modules.

Evaluation Form (.pdf, 413 KB, 4 pgs)

Please return the completed form to:

Family Health International
Training and Education Unit
P.O. Box 13950
Research Triangle Park, NC 27709
United States of America

Fax number: (919) 544-7261

Contraceptive Technology and Reproductive Health Series: Home Page