Questionnaire Evaluation

Dear Parent,

Would you please take a few minutes to evaluate our questionnaires? We appreciate your participation in our program and hope that our services have been helpful to you.

Please circle the number that best expresses your opinion.

1. Approximately how many minutes did it take you to fill out each questionnaire?

___ minutes. Did you consider this amount of time:

• very little time
• too much time
  1 2 3 4
  Comments:

2. Did the questionnaires alert you to skills your child has or activities your child could do that you were not sure about?

3. After filling out the questionnaires, did you have any new ideas about how to interact or play with your child?

If you have any further comments about the questionnaires, please write them on the back of this form.

5. Did you enjoy participating in this program?

Estimado/a padre o madre de familia,

Le agradecemos su participación en el programa y esperamos que nuestros servicios le hayan sido de ayuda. ¿Podría tomar unos momentitos para evaluar nuestros cuestionarios?

Favor de trazar un círculo alrededor del número que mejor expresa su opinión.

1. Aproximadamente, ¿cuántos minutos tardó en completar cada cuestionario?

___ minutos. Le pareció que esto fue:

Comentarios:

2. Al completar los cuestionarios, ¿reconoció habilidades que su niño/a tiene o notó algunas actividades que él/ella puede hacer que usted no había notado hasta ahora?

3. Después de completar los cuestionarios, ¿se le ocurrieron nuevas ideas de cómo interactuar o jugar con su niño/a?

4. ¿Había preguntas que le parecieron difíciles de entender?

Si usted tiene comentarios adicionales sobre los cuestionarios, favor de escribirlos al dorso de este formulario.

ABOUT YOU (write in your specialty and check one field that best applies)

Specialty

• Birth to Five
• Birth to Five K–12
• Clinical/Medical Personnel
• 4-year College/Grad.
• Comm. College/Vocational
• Association/Foundation
• Comm. Services

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• Expiration date: __ __ /__ __
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CALL toll-free 1-800-638-3775 M-F, 9 a.m. to 5 p.m. ET.; FAX 410-337-8539;
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