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ANSWER SHEET - NAADAC/CAADAC/CAADE
Last Name First Name MI
Today's Date
mm/dd/yyyy
License 1
License # or
Certificate # 		State where licensed   Title
Expiration Date
mm/dd/yyyy
 Title Other:
License 2 (if applicable)
License # State where licensed   Title
  Expiration Date
mm/dd/yyyy		 Title Other:

Mailing Address
City
State
Zip
Phone
Fax
Email

For True/False questions: A=True and B=False.
Click, pencil or pen your answers.
ETHICS
A B C D
1.
2.
3.
4.
5.
A B C D
  6.
  7.
  8.
  9.
10.
A B C D
11.
12.
13.
14.
15.
A B C D
16.
17.
18.
19.
20.
SUBJECTIVE WELL-BEING (Happiness)
A B C D
1.
2.
3.
4.
5.
A B C D
  6.
  7.
  8.
  9.
10.
A B C D
11.
12.
13.
14.
15.
A B C D
16.
17.
18.
19.
20.
HEALTHY PERSONALITY
A B C D
1.
2.
3.
4.
5.
A B C D
  6.
  7.
  8.
  9.
10.
A B C D
11.
12.
13.
14.
15.
A B C D
16.
17.
18.
19.
20.
HEALTHY AGING
A B C D
1.
2.
3.
4.
5.
A B C D
  6.
  7.
  8.
  9.
10.
A B C D
11.
12.
13.
14.
15.
A B C D
16.
17.
18.
19.
20.
DOMESTIC VIOLENCE
A B C D
1.
2.
3.
4.
5.
A B C D
  6.
  7.
  8.
  9.
10.
A B C D
11.
12.
13.
14.
15.
A B C D
16.
17.
18.
19.
20.

COURSE EVALUATION (OPTIONAL)
If you do not wish to complete the evaluation you may skip this step and continue submitting your answer sheet by clicking the "Submit" button below.

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. 12345
2. Course information was clearly presented.12345
3. Course format was well planned.12345
4. The course was effectively executed.12345
5. Program content was beneficial to me.12345
6. Learning objectives were clearly stated at the onset of the course.12345
7. Learning objectives were specific and measurable.12345
8. The learning objectives met my professional needs.12345
9. Course presentation met the stated learning objectives.12345
10. The author was knowledgeable of the subject matter.12345
11. I would recommend this course to a colleague.12345
12. I would take another course from this author.12345
13. I valued the course information.12345
14. The course met my professional expectations.12345

15. Please comment on strengths and weaknesses of this program.
16. Please suggest any improvements you recommend to this program.
Ethics$59$

Subjective Well-Being

$59$
Healthy Personality$59$
Healthy Aging$59$
Domestic Violence$59$
Total for all courses$


Please return my Certificates of Completion by mail.
Please return my Certificates of Completion to fax number above.
Please return my Certificates of Completion to the following e-mail address.


#1. To send by fax or mail: Complete and send this answer sheet without need to perform step #2. Complete credit card information below, if applicable.
#2. To send by email: For online secure payment CLICK HERE
Charge this to my Visa/Mastercard/Discover:
Card # Expires (mm/dd/yy)



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