I certify that I am the above-named person completing this form and that the information I submit here is accurate. *

1. How much did you learn as a result of this CE program? 5 = Very much, 1 = Very little *

2. Rate the quality of the program content 5 = Very High, 1 = Very Low *

3. Rate how current/relevant the program content is 5 = Very current/relevant, 1 = Not current/not relevant at all *

4. How useful was the content of this CE program for your practice or other professional development? 5 = Extremely Useful, 1 = Not Useful at all *

5. Rate the instructor’s knowledge and expertise of the subject 5 = Very High, 1 = Very Low *

6. Rate the instructor’s teaching ability 5 = Very High, 1 = Very Low *

7.1. Would you agree that learning objective #1 was met?
Learning Objective #1: “Demonstrate skills for deeply listening to and understanding clients,” 5 = Strongly agree, 1 = Strongly disagree *

7.2. Would you agree that learning objective #2 was met?
Learning Objective #2: “Describe four components of the “spirit” of motivational interviewing,” 5 = Strongly agree, 1 = Strongly disagree *

7.3. Would you agree that learning objective #3 was met?
Learning Objective #3: “Explain the difference between motivational interviewing and person-centered and other models of care,” 5 = Strongly agree, 1 = Strongly disagree 5 *

7.4. Would you agree that learning objective #4 was met?
Learning Objective #4: “Enact skills for responding to others with complex, empathic reflective statements using open questions to “move” the conversation,” 5 = Strongly agree, 1 = Strongly disagree *

7.5. Would you agree that learning objective #5 was met?
Learning Objective #5: “Identify ‘change talk’ within a person’s statements,” 5 = Strongly agree, 1 = Strongly disagree *

7.6. Would you agree that learning objective #6 was met?
Learning Objective #6: “Provide a crisp empathic summary statement collecting change talk with a closing inquiry/ open question,” 5 = Strongly agree, 1 = Strongly disagree 5 *

8. Rate how well the program met your expectations (according to the promotional materials) 5 = Very well, 1 = Not well at all *

9. Rate the quality of the provided course materials 5 = Very High, 1 = Very Low *

10. Rate the quality of the facilities (in-person) or technology (online). 5 = Very High, 1 = Very Low *

11. Rate how well disability accommodations were met, if requested. 5 = Very well, 1 = Not well at all *

12. Rate the ease of the registration process 5 = Very Easy, 1 = Very Difficult *

13. Rate the instructor(s) responsiveness to questions 5 = Very responsive, 1 = Not responsive at all *

14. Rate the program staff’s responsiveness to questions 5 = Very responsive, 1 = Not responsive at all *