Pacific Crest Institute Assessment Form

Please take a few minutes to share your assessment of the recent event you attended.

Name Date of Event
Institution Event Name
Department Position
Email Address Phone Number

May we e-mail you our quarterly newsletter, Reflections? (you may unsubscribe at any time)

 Yes   No

May we e-mail you a FREE bi-weekly Insight? (you may unsubscribe at any time)

 Yes   No

May we share your comments about this event with others?

Yes   No 

Would you like to learn more about the annual Process Education conference, sponsored by the Academy of Process Educators?

Yes   No 
 

Interest in future faculty development events or opportunities offered by Pacific Crest

Please let us know your interest in the following:

I am interested in being a mentor at a Teaching Institute.

 Yes   No 

I am interested in coaching at a Learning-to-Learn Camp.

 Yes   No 

I am interested in learning more about Process Education.

 Yes   No 

Interest in Pacific Crest's publications or publishing services
Please let us know your interest in the following:

I am interested in purchasing a copy of the Faculty Guidebook or getting access to the on-line version of the Faculty Guidebook

I am interested in having Pacific Crest publish my material for the following course:  

I am interested in the following Pacific Crest publication:  

Feedback about the Institute

   Logistics, set-up, and organization (use the sliders to rate the following):

usefulness of
preparation materials

 not useful at all slightly useful useful very useful extremely useful  
 

 

quality of facilities used

 very low quality low quality neutral good quality very high quality  
 

 

food and refreshments

 very low quality low quality neutral good quality very high quality  
 

 

   Content and processes (use the sliders to rate the following):

degree to which your expectations were met

 not met at all some were met most were met met all expectations beat my expectations  
 

 

your level of interest in the content presented/covered

 no interest at all low medium high extremely high  
 

 

quality of the materials
used for the Institute

 very low quality low quality neutral good quality very high quality  
 

 

interest in participating in future institutes/events

 no interest at all low I'll think about it high extremely high  
 

 

Assess the Institute using the SII Method:

Strengths (including why):

Areas for Improvement (including how):

Insights (including significance):
Identify the two activities you found most valuable and the two activities you found least valuable:

MOST valuable

LEAST valuable

What are the two most important things you learned at the Institute?
#1 #2
 

Feedback about the Facilitator(s)

 (use the sliders to rate the following):

effectiveness of the
facilitator(s)

 not effective at all slightly effective somewhat effective effective extremely effective  
 

 

pacing of activities

 very poorly paced poorly paced neutral well paced very well paced  
 

 

responsiveness to participant needs

 not at all responsive somewhat responsive met obvious needs very responsive anticipated needs  
 

 

Assess the facilitator(s) and mentors (when appropriate) using the SII Method:

Facilitator Name: Facilitator Name:
Strengths (including why):

Areas for Improvement (including how):

Insights (including significance):
Strengths (including why):

Areas for Improvement (including how):

Insights (including significance):

Please share any additional comments or feedback you may have!