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Course Evaluation Form

AMERICAN INSTITUTE OF HEALTH CARE PROFESSIONALS, INC.

Thank you for completing your Continuing Education Course and Congratulations! The final step is your completion of the Course Evaluation. This will take a few minutes of your time. You must complete the following course evaluation to receive your credit hours and your certificate of course completion.

Please complete the evaluation below and be sure to complete all required information. When finished, be sure to click the submit button. Your score and credits will be recorded once your completed evaluation is received. We will then prepare your CE certificate and it will be postal mailed to you.

Keep in mind when filling out the evaluation to list your first and last name in the appropriate blank because that is how your name will be listed on the certificate for the course. We do not list titles, or degrees on any of our certificates but only the first and last name. If any errors occur on the certificate due to improper listing on this form then it is the student’s responsibility for a new certificate. A $5 fee to process a new certificate will be charged in these cases for a new certificate. So please make sure your name is correct and the postal address is accurate and up to date.

Once correctly submitted you will see a “thank you” note below this line:

"*" indicates required fields

Name*

First Last

Email*

AH/Student ID Number*

Please input your Student ID Number

Course Code & Title*

Course Code(s)

Type in The Course Code Below

Date Completed*

Month

Day

Year

Enter the date you completed the course

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please rate questions 1 through 12 using this rating scale: 5 = Excellent, 4 = Very Good, 3 = Good, 2 = Fair, 1 = Poor.

Question 1 -The Course Met My Expectations For Learning:*

Please enter a number from 1 to 5.

Question 2 - I Achieved The Stated Course Objectives:*

Please enter a number from 1 to 5.

Question 3 - The Text And Other Materials Used Were Conducive To Learning:*

Please enter a number from 1 to 5.

Question 4 - The Examination Was Fair And Tested Learning Appropriately:*

Please enter a number from 1 to 5.

Question 5 - The Course Syllabus Was Complete And Easy To Follow:*

Please enter a number from 1 to 5.

Question 6 - The Course Content Related To The Course Objectives:*

Please enter a number from 1 to 5.

Question 7 - I Was Able To Learn From This Method Of Course Presentation:*

Please enter a number from 1 to 5.

Question 8 - The Examination Facilitated Further Learning Of The Course Content:*

Please enter a number from 1 to 5.

Question 9 - Any Questions I Had Were Answered In A Timely Manner By AIHCP Staff:*

Please enter a number from 1 to 5.

Question 10 - My Experience Overall With This Course Was:*

Please enter a number from 1 to 5.

Question 11- How Many Hours Of Study Did You Spend On This Course (Including Exam)?:*

Please enter a number from 1 to 999.

Question 12 - The Course Demonstrated The Author's Knowledge:*

Please enter a number from 1 to 5.

Question 13 Rating Scale: Please rate the following statement using this rating scale: 5 = Great, 4 = Some, 3 = Neutral, 2 = Little, 1 = Very Little.

Question 13 - How Much Did You Learn As A Result Of This CE Program?*

Please enter a number from 1 to 5.

Question 14 Rating Scale: Please rate the following statements using this rating scale: 5 = Extremely Useful, 4 = Somewhat Useful, 3 = Useful, 2 = Slightly Useful, 1 = Not Useful.

Question 14 - How Useful Was The Content Of This CE Program For Your Practice Or Other Professional Development?*

Please enter a number from 1 to 5.

Questions 15 Through 20: Please respond with a "Yes" or "No."

Question 15 - Was The Course Content Free Of Bias?:*

Yes

No

Question 16 - Before Completing The Course Did You Identify The Necessity For Education On The Topic/Subject To Improve Or Enhance Your Professional Practice?:*

Yes

No

Question 17 - Has What You Think Or Feel About This Topic/Subject Changed?*

Yes

No

Question 18 - I Would Recommend This Course To Other Professionals:*

Yes

No

Question 19 - Are You More Confident In Providing Patient Care After Completing This Course?:

Yes

No

Question 20 - Was Self-Paced Learning Effective For You:?*

Yes

No

Please read the section below and answer the following questions.

Question 21 - Are You A Licensed Health Care Professional In Any Of The Following States That Report CE’s Through CE Broker (Www.Cebroker.Com) In Which The Course You Have Taken From AIHCP Is Listed As An Approved Course For You For CE Credits?*

Yes

No

Question 22 - Are You A Licensed RN/LPN/APN In Any State in the United States (including DC)?*

Yes

No

Question 23 - Are You a Licensed RN/LPN/APN in the State of Florida or the District of Columbia (Washington DC)?*

Yes

No

Question 24 - Are You a Licensed RN/LPN/APN in Any of the Following States That Report CE's to CE Broker - AK, GA, KY, NM, SC, or WV*

Yes

No

If you answered (Yes) to any of the above questions, or if you Report CE’s Through CE Broker (Www.Cebroker.Com) please provide your nursing or professional license number as well as your state you are licensed in. You must provide your license number in the area provided below. This is mandated by the Nursing Boards that have given us our CE Approved Provider Status. We cannot issue you a CE certificate or CE hours unless you provide your license number below. Thank you.

License Number:

State:

ATTESTATION: I certify that I have read/studied the course materials and any additional course assignments and I have personally completed the final examination based on the materials presented.*

Yes

No

Recommendations/Comments

In the area above please feel free to make recommendations for future CE courses provided by AIHCP.

Comment Usage:

Yes

No

May We Use Your Comments As A Post On Our Website Regarding Your Experiences With This Course?

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Thank you for completing this course and the course evaluation. All evaluations are reviewed carefully by our staff and board. Your participation is appreciated.

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