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| Course Information |
| Q1. | Select the Course Completed |
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| Q2. | Enter the date of the course |
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| Q3. | Enter the name of the training center offering the course |
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| Q4. | Enter the instructor's name who taught the course |
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| Program Content |
| Q5. | Organization, Pace and Flow |
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| Q6. | Not Too Basic, Not Too Complex |
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| Q7. | Skill Demonstrations, Time Allowed for Practice |
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| Q8. | Increased Your Confidence & Ability To Take Action |
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| Training Center Teaching Staff |
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| Q10. | Enthusiastic, Friendly |
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| Q11. | Sincere, Considerate, Helpful |
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| Q13. | Organized, Effective |
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| Program Materials |
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| Q15. | Audiovisual Materials |
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| Physical Facilities |
| Q16. | Space For Lectures and Skill Stations |
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| Overall Impression |
| Q18. | How would you score the overall course |
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| Q19. | What did you like most about this course |
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| Q20. | What did you like least about this course |
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| Q21. | Would you recommend this course to others |
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| Yes
No
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| Q22. | Please enter your email address for course content updates, recertification reminders and a free online refresher. |
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| Q23. | Please enter your contact information below in order for ASHI to follow up on any negative ratings. |
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