CNE Evaluation Form – MOBI & TIES Train-the-Trainer March 3 Name * First Last Name * Last Credentials * Practice/Organization * Email Address * Phone Number * Address * Address 2 City * State * ------AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Experience Level * New Trainer Experienced Trainer Training Objectives: At the conclusion of this activity, are you able to: Define the MOBI background and mission * Yes No Identify current recommended childhood and adolescent immunizations schedules * Yes No Describe recent changes in immunizations recommendations * Yes No Identify procedures for conducting MOBI & TIES programs Yes No Identify online documentation for MOBI & TIES programs Yes No Speaker for New Trainers Only: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. Speaker demonstrated teaching effectiveness: Rebecca Brady, MD, FAAP * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Robert Frenck, Jr., MD, FAAP * 1 2 3 4 5 Speakers: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. Speaker demonstrated teaching effectiveness: Sarah Duade * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Lory Sheeran Winland, MPA * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Angela Krile * 1 2 3 4 5 OVERALL PRESENTATION: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. The presentation was well organized and logically sequenced. * 1 2 3 4 5 The material was not too difficult to understand. * 1 2 3 4 5 I gained new information. * 1 2 3 4 5 How would you rate your overall satisfaction with this activity? * Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Additional Comments: By signing or typing your name, you confirm your identity and attest to attending the entire educational activity. * Clear If you are human, leave this field blank.
