Fillable PROGRAM EVALUATION 13.MSE.ST.PCS.PTSD.EAP.A SUPPORTING VETERANS IN THE WORKPLACE: (U.S. Department of Veterans Affairs)

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PROGRAM EVALUATION 13.MSE.ST.PCS.PTSD.EAP.A SUPPORTING VETERANS IN THE WORKPLACE: (U.S. Department of Veterans Affairs)

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PROGRAM EVALUATION
COURSE NUMBER:
13.MSE.ST.PCS.PTSD.EAP.A
ACTIVITY TITLE:
SUPPORTING VETERANS IN THE WORKPLACE: A COURSE FOR
EMPLOYEE ASSISTANCE PROGRAM PROVIDERS
Program Contact
KAITLYN THIES, LAURAN HARDY
Contact Email
EESEPC@VA.GOV
Contact Phone
COURSE NUMBER:
13.MSE.ST.PCS.PTSD.EAP.A
PROGRAM EVALUATION
SUBMISSION INSTRUCTIONS
1. Complete this registration and evaluation form within 30 days of completing the activity.
2. Please save and email a copy of your completed evaluation to
EESEPC@va.gov
3. Your certificate will be sent via email to the email address provided below.
4. For questions or concerns regarding the Program Evaluation or Certificate, the following contact methods are
available: EPC by email at
EESEPC@va.gov
, or the EES Customer Service by phone at 1.877.EES.1331 Opt.5
OCCUPATIONAL CATEGORY
Administrative
Advanced Practice Nurse
Associated/Allied Health
Clinical P
sychologist
Dentist
Licensed Clinical Social Worker
Pharmacist
Pharmacy Tech
Phy
sician
Physician Assistant
Podiatrist
Registered Dietitian
Registered Nurse
Speech/Language Pathologist
Other Clinical
Other
EMPLOYER CATEGORY
VHA
VBA
NCA
VA OTHER
DOD
IHS
OTHER FEDERAL
NON FEDERAL
Date Completed
/ /
ACCREDITATION/CERTIFICATE REQUESTED:
Activity must be approved for the certificate type in order for such a certificate to be issued.
General/Non-Accredited
ACCME
ACCME - Non Physician
ACHE
ACPE
ACPE-Technician
ADA
ANCC
APA
ASHA
ASWB
CA BBS
CA BRN
CDR
NBCC
EMAIL ADDRESS: Enter Complete Email Address
LAST NAME:
FIRST NAME:
I assert that I attended 100% of this program:
e-Signature:
Type your full name in the block above
PRIVACY ACT STATEMENT
AUTHORITY: Title 50, Appendix, U.S.C., Title 10, U.S.C., Public Law 96-357 96th Congress, September 24, 1980 (Amendment to 10 U.S.C.
2107).
PRINCIPAL PURPOSE(S): To develop policies and procedures, compile statistics and render analytical reports, and to track participation in
EES activities.
ROUTINE USES: The information provided on the application will be used to maintain data on EES activities, provide requested reports on
participation, and to provide activity original and duplicate certificates to EES activity participants.
MANDATORY
AND VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL PROVIDING INFORMATION: Disclosure of information
requested in the EES registration form (the application) is voluntary; however, the information must be furnished in order to ensure the
applicant will receive a certificate of completion for EES activities and appropriate education credit.
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13.MSE.ST.PCS.PTSD.EAP.A
PROGRAM EVALUATION
COURSE NUMBER:
PLEASE CIRCLE THE APPROPRIATE RESPONSE
CORRESPONDING WITH EACH QUESTION BELOW:
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
Not
Applicable
Overall, I was satisfied with this learning activity.
1 2
3 4 5
NA
The learning activities and/or materials were effective
in helping me learn the content.
1 2
3 4 5
NA
I learned new knowledge and skills from this learning
activity.
1 2
3 4 5
NA
The scope of the learning activity was appropriate to my
professional needs.
1 2
3 4 5
NA
The content of the learning activity was current.
1 2
3 4 5
NA
Was the content presented in a manner that was fair and
balanced?
Yes No NA
If no, please explain:
If you feel you will be successful in applying this
learning, please provide a few specific examples of how
you will apply it.
I will be able to apply the knowledge and skills learned
to improve my job performance.
1 2
3 4 5
NA
If you required any accommodations for a disability your
request was addressed respectfully and in a timely manner.
1 2
3 4 5
NA
The appropriate technology was utilized to facilitate my
learning.
1 2
3 4 5
NA
The training environment (face to face, video conference,
web based training) was effective for my learning.
1 2
3 4 5
NA
I found that the technology in this learning activity
was easy to use.
1 2
3 4 5
NA
Overall, I was satisfied with the use of technology in this
learning activity.
1 2
3 4 5
NA
The technology in this learning activity was responsive
and provided access to further support.
1 2
3 4 5
NA
What about this learning activity was most useful to
you?
What about this learning activity was least useful to
you?
Thank you for your helpful feedback.
COURSE NUMBER:
13.MSE.ST.PCS.PTSD.EAP.A
PROGRAM OBJECTIVES
Please rate each of the following program objectives.
After attending this learning activity, I have the ability to:
Strongly
Disagree
Disagree Neutral Agree
Strongly
Agree
Distinguish differences in hierarchy and management style when
transitioning from military to civilian workplaces;
Describe how military resilience training can impact the transition to
civilian life and the workplace;
Identify ways to help Veterans communicate with peers,
supervisors, or employers in order to address challenges.
Recognize how myths and stereotypes about Veterans can impact
the work environment.
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PROGRAM EVALUATION 13.MSE.ST.PCS.PTSD.EAP.A SUPPORTING VETERANS IN THE WORKPLACE: (U.S. Department of Veterans Affairs)

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Completed 2 August 2020

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