Training/Presentation Evaluation Form

Basic Information
Date of Training/Presentation*
MM slash DD slash YYYY
Name of Trainer/Presenter
First Last
Your Name*
Your Organization/School Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*

Demographics
For all known fields, please indicate the number of attendees in each of the following demographics. If there are zero participants who fit one of the following demographics, please type the number zero (0).
Gender Identity
Female*
Please enter a number greater than or equal to 0.
Male*
Please enter a number greater than or equal to 0.
Nonbinary*
Please enter a number greater than or equal to 0.
Prefer Not to Specify*
Please enter a number greater than or equal to 0.
Age
0 - 4*
Please enter a number greater than or equal to 0.
5 - 9*
Please enter a number greater than or equal to 0.
10 - 14*
Please enter a number greater than or equal to 0.
15 - 17*
Please enter a number greater than or equal to 0.
18 - 20*
Please enter a number greater than or equal to 0.
21+*
Please enter a number greater than or equal to 0.
Race & Ethnicity
White (Caucasian)*
Please enter a number greater than or equal to 0.
Hispanic, Latinx, or Spanish*
Please enter a number greater than or equal to 0.
Black or African American*
Please enter a number greater than or equal to 0.
Asian*
Please enter a number greater than or equal to 0.
American Indian/Native American*
Please enter a number greater than or equal to 0.
Other*
Please enter a number greater than or equal to 0.
If Other, Please Specify:*

Basic Information