Evaluation (Completion of this form is mandatory)
Elite Learning
PYPA1525
Last Name ____________________________________________ First Name _ ___________________________________ MI _ _____ State ____________________________ License # _______________________________________ Expiration Date _ _____________
To receive continuing education credit, completion of this Evaluation is mandatory.
Please read the following questions and choose the most appropriate answer for each course completed. 1. Was the course content new or review? 2. How much time did you spend on this activity, including the test questions? 3. Would you recommend this course to your peers? 4. Did the course content support the stated course objective? 5. Did the course content demonstrate the author’s knowledge of the subject? 6. Was the course content free of bias? 7. Before completing this course, did you identify the necessity for education on the topic to improve your professional practice? 8. Have you achieved all of the stated learning objectives of this course? 9. Has what you think or feel about this topic changed? 10. Did evidence-based practice recommendations assist in determining the validity or relevance of the information? 11. Are you more confident in your ability to provide patient care after completing this course? 12. Do you plan to make changes in your practice as a result of this course content? In accordance with the reporting requirements of Act 31, please provide the following information for Course 1: 13. Please provide the last four digits for your social security number. 14. Please provide your date of birth.
Child Abuse Identification and Reporting: The Pennsylvania Requirement 3 CE Credit Hrs
Ethics for Psychologists 6 CE Credit Hrs
Suicide Assessment and Prevention 6 CE Credit Hrs
1. New
1. New
1. New
Review 2. _____ Hours 3. Yes
Review 2. _____ Hours 3. Yes
Review 2. _____ Hours 3. Yes
No No No No No No No No No
No No No No No No No No No
No No No No No No No No No No
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes 12. Yes
10. N/A 11. Yes 12. Yes
12. Yes No 13. ___ ___ ___ ___ 14. ___/___/______ (mm/dd/yyyy)
Child Abuse Identification and Reporting: The Pennsylvania Requirement — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? __________________________________________________________
Ethics for Psychologists — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdis- ciplinary team? ____________________________________________________________________________________________________
Suicide Assessment and Prevention — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________________________________________________
Signature _________________________________________________________________________________ Signature required to receive continuing education credit.
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EliteLearning.com/Psychology
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