Name: 

Using a scale of 1 (not effective) through 5 (highly effective), please answer, by filling in a number, the following questions:	Poor		Excellent
	1	2	3	4	5
1. The overall quality of the online training module was:
2. The appropriateness of the teaching strategy (web-based learning module) was:

3. The objectives of the training module are listed below. 
   By the end of this training session participants will be able to:
   1. Understand and Implement the 5 A's, Counseling Tool to Help Clients Quit Smoking,
   2. Identify useful handouts that coordinate with each stage of the 5A's to assist clients quit smoking,
   3. Implement the 5 R's for motivational counseling, and
   4. Identify Potential additional resources for additional information

   Were the objectives met?  Yes No

4. Were the objectives related to the overall purpose/goal of activities?
    Yes No

5. List which module topic area(s) that were most valuable to you and why?
   1.
   2.
   3.

6. In what ways do you plan to apply the information and/or skills gained from this online training?
   

7. Identify potential challenges you may have in using the ideas presented in the training module.
   

8. Please list ways to improve this module.
   

9. Did you feel that the workshop curriculum and presentation was sensitive to cultural, ethnic and racial issues?
   

10. How long did it take you to complete this activity? hours minutes

11. Please feel free to write any comments you might about about this training module.