AGD Course Evaluation Form
We are constantly trying to improve the quality of our continuing education courses. Please take a few minutes at the
completion of the program to evaluate this course and presenter. Thank you.
Course Title:
___________________________________
Date:
_______________________
Presenter:
___________________________________
Location:
_______________________
Program Provider: ___________________________________
Course Type:
Lecture
Participation
Please check one of the following:
___ AGD Dentist (Are you an AGD Fellow? ___ Are you an AGD Master? ___)
___ Dental Team
___ Office Staff
___ Scout
___ Non-AGD Dentist
___ Other
PLEASE CIRCLE YOUR RESPONSE TO EACH OF THE FOLLOWING:
Strongly
Disagree
Strongly
Agree
1. Meeting site was adequate in size, comfortable, and convenient.
2. Course administration was efficient and friendly.
3. Course objectives were consistent with the course as advertised.
4. Course material was up-to-date, well organized, scientifically sounds, and presented in
sufficient depth.
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5. Instructor demonstrated a comprehensive knowledge of the subject.
6. Instructor appeared to be interested and enthusiastic about the subject.
7. Instructor spoke clearly and distinctly.
8. Instructor encouraged questions and participation.
9. The instructor presented a balanced view of therapeutic options and used generic/noncommercial terms whenever possible
10. Audio-visual materials used were relevant and of high quality.
12. Handout materials enhanced course content.
13. Information designed to promote the sale of use of a specific material, devise or
service was kept separate from the continuing education program.
14. Overall, I would recommend this course to others.
15. Overall, I would consider attending other courses offered by this instructor.
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Comments (Positive or Negative): _____________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Other topics and/or speakers you would like offered: _____________________________________________________
___________________________________________________________________________________________________
Please submit this form to your constituent's CE Chairperson following completion of the course.
Course SUMMARY Form (Speak Easy)
CE Chair: Please tally the evaluation scores and place the averages on this sheet. Submit only this form to the
AGD.
Course Title:
________________________________________________
AGD Subject Code: __________
Presenter:
________________________________________________
Location: ___________________
Program Provider: ___________________________________
Date: ______________________
Corporate Sponsors: ______________________________________________________________________________
Course Type:
Lecture
Participation
Speaker Contact Information:
Name:
_________________________________
Telephone: ________________________
Address:
_________________________________
Facsimile:
_________________________________
E-Mail Address:
City/State/Zip:_________________________________
___ AGD Dentist (Fellows ___ Masters ___)
___ Dental Team
___ Office Staff
Total Course Attendees: ______
________________________
___________________________________
___ Non-AGD Dentist
___ Scout
___ Other
Number of Survey Respondents: ______
PLEASE INDICATE THE AVERAGE SCORE FOR EACH OF THE FOLLOWING:
Average
Score
1. Meeting site was adequate in size, comfortable, and convenient.
2. Course administration was efficient and friendly.
3. Course objectives were consistent with the course as advertised.
4. Course material was up-to-date, well organized, scientifically sounds, and presented in
sufficient depth.
5. Instructor demonstrated a comprehensive knowledge of the subject.
6. Instructor appeared to be interested and enthusiastic about the subject.
7. Instructor spoke clearly and distinctly.
8. Instructor encouraged questions and participation.
9. The instructor presented a balanced view of therapeutic options and used generic/noncommercial terms whenever possible
10. Audio-visual materials used were relevant and of high quality.
12. Handout materials enhanced course content.
13. Information designed to promote the sale of use of a specific material, devise or
service was kept separate from the continuing education program.
14. Overall, I would recommend this course to others.
15. Overall, I would consider attending other courses offered by this instructor.
Overall Average Score:
_______
(Average Shaded Area Only)
Comments (Positive or Negative): _____________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Other topics and/or speakers you would like offered: _____________________________________________________
___________________________________________________________________________________________________
Please return only the Summary Form to Sheena Lilly, Coordinator, Education:
Academy of General Dentistry, Attn: Sheena Lilly
211 E. Chicago Ave. Suite 900, Chicago, IL 60611
Fax: 312.440.0513, Attn: Sheena / E-mail: Sheena.Lilly@agd.org / Phone: 888.243.3368, ext. 4326