Speak Out : Evaluate a Program

* Name of Speaker/Artists/Exhibit/Film

Date of Event

Sponsoring Campus/Organization

* City

* State

On a scale of 1-5 (5 = highest and 1 = lowest) please respond to the following:

How would you rate the overall quality of the presentation?

I learned new information from the presentation.

As a result of this presentation, my opinion changed about the topic.

As a result of this presentation, I am more likely to get involved in efforts around the topic.

I would attend another presentation by this speaker/artist.

COMMENTS (please elaborate on any of the above, let us know what you enjoyed most/least about the presentation, any new insight you gained from this event, etc.)

Name

Are you interested in other presenters on this topic?

Are you interested in programs on other topics?

If yes, what topics:

Would you like to receive more information on how to get involved around this issue/topic?

If you answered yes above, please provide the following:

To help us better know more about who we are reaching, please tell us about yourself:

Gender

Age

Race/ethnicity

Sexual orientation

Other

First Name

* Required Field