SAMHSA Minority Fellowship Program (MFP)

Evaluation Form

This form is designed to provide the Substance Abuse and Mental Health Services Administration (SAMHSA) with your assessment of the conference. Please take the time to answer the questions by circling the number that corresponds to your rating and then return the completed form to the registration desk.

Scale:	Excellent=1	Very Good=2	Good=3	Poor=4	NA=No Assessment
Rating of Objectives and Program
Please rate the attainment of conference objectives.
	1	2	3	4	NA
Please rate the overall quality of the instructional process as an asset to the program.
	1	2	3	4	NA
Please rate the extent that participation in this conference enhanced your professional effectiveness.
	1	2	3	4	NA

Friday, December 12, 2003

*Keynote Addresses* Power, Clark, and B. Davis	1	2	3	4	NA
Plenary: Fellows' Five SAMHSA Areas of Most Interest	1	2	3	4	NA
Luncheon Program: Roundtable Discussion	1	2	3	4	NA
*Afternoon Breakout Group I*	1	2	3	4	NA
*Afternoon Breakout Group II*	1	2	3	4	NA

Saturday, December 13, 2003

*Keynote Address: K. Davis* Cultural Competence and Reducing Health Disparities	1	2	3	4	NA
Web-Based Information Technology Session	1	2	3	4	NA
Luncheon Program: Roundtable Discussion	1	2	3	4	NA
*Breakout Group III*	1	2	3	4	NA
Rating of Conference Components
Conference overall	1	2	3	4	NA
Conference materials	1	2	3	4	NA
Conference registration	1	2	3	4	NA
Logistics staff assistance	1	2	3	4	NA
Hotel accommodations	1	2	3	4	NA
Adequacy of meeting rooms	1	2	3	4	NA
Subject matter was adequately covered.	Agree	Disagree
Content was suitable for my background/experience.	Agree	Disagree
Program was well paced within the allotted time.	Agree	Disagree
Speakers encouraged active attendee participation.	Agree	Disagree

Comments

1. Please list the specific actions you will take when you return to your job or training program to implement the new ideas and strategies you obtained during this conference.

2. What topics and/or sessions were most useful to you?

3. What Topics and/or sessions were least useful to you?

4. Are there topics and/or speakers you would like to suggest for future conferences?

5. Do you have additional comments to improve the quality of the conference?

Please return this form to the conference registration desk. Thank you!