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ANSWER SHEET (Online-Texas)
| Last Name _____________________ First Name __________________M.I.
___ |
| License # ______________ State Where Licensed ____Expiration
Date ________ |
| Title (i.e. LPC, LMSW, Psychologist, etc.) _____________ Today’s
Date _______ |
| Mailing Address ___________________________________________________ |
| City ____________________________ State _________ Zip _______________ |
| Phone Number ___________________ FAX Number _____________________ |
For True/False questions: A=True and B=False.
Click, pencil or pen your answers. |
| SUBJECTIVE WELL-BEING |
| |
|
| |
|
Subjective Well-Being ....................... $25 ..............................
$ _________ |
| Healthy Personality ............................
$25 .............................. $ _________ |
| Ethics .................................................$59
.............................. $ _________ |
| Domestic Violence...............................$59
.............................. $ _________ |
|
Healthy Aging ..................................... $59 .............................
$ _________ |
| Total .........................................................................................$
_________ |
| ___ |
Please return my Certificates of Completion
by mail. |
| ___ |
Please return my Certificates of Completion
to fax number above. |
| ___ |
Enclosed is my check/money order (payable to
Continuing Psychology Education Inc., or simply CPE). |
| ___ |
Charge this to my Visa/Mastercard/Discover:
(Please include additional 3 numbers on back of credit card,
if applicable) |
| Card # ________________________________________
Expires ___________ |
| Signature ________________________________________________________ |
COURSE EVALUATION (OPTIONAL)
Please respond to the following questions utilizing
this Likert Scale.
Strongly Agree - 5
Agree - 4
Neutral - 3
Disagree - 2
Strongly Disagree - 1
1. Course content was comprehensive. ___
2. Course information was clearly presented. ___
3. Course format was well planned. ___
4. The course was effectively executed. ___
5. Program content was beneficial to me. ___
6. Learning objectives were clearly stated at the onset of the course.
___
7. Learning objectives were specific and measurable. ___
8. The learning objectives met my professional needs. ___
9. Course presentation met the stated learning objectives. ___
10. The author was knowledgeable of the subject matter. ___
11. I would recommend this course to a colleague. ___
12. I would take another course from this author. ___
13. I valued the course information. ___
14. The course met my professional expectations. ___
15. Please comment on strengths and weaknesses of this program.
16. Please suggest any improvements you recommend
to this program.
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