FIVE TOWN CSD
Adult & Community Education
25 Keelson Drive, Rockport, ME 04856
FAX (207) 230-1059 – email@example.com – www.fivetowns.maineadulted.org
We are continually trying to improve our program. We want to know what you thought of the Adult Ed class you took and what classes you would like to see in the future. After you complete this form, drop it off, mail or fax it to us. We also appreciate any comments you would like to email directly without using this form.
Thank you for taking the time to give us feedback.
Instructor: ______________________________ Date: ____________________
- Please rate how you feel about this statement: “This course met my expectations and learning objectives.” If disagree or strongly disagree, please explain on the back of the page.
Strongly Agree / Agree / Neither Agree nor Disagree / Disagree / Strongly Disagree
- Is there any advice you would like to offer the instructor so that he or she could make the course even better? If yes, please amplify.
- Are there other courses you would like to see offered in the future?
- Are there any courses that you would like to TEACH in the future? (If yes be sure to give us your NAME AND PHONE NUMBER)
- How did you hear about this course?
- Catalog in mail
- Picked up catalog at area business
- Camden Herald/Courier Gazette (newspaper)
- Free Press
- Village Soup (online)
- Pen Bay Pilot
- From a friend
- Best Customer Email
- Additional comments?
NOTE: If you would like to be on our “Best Customer” email list to receive updates on forthcoming courses, please PRINT YOUR NAME AND EMAIL LEGIBLY below:
We are also on Facebook! To become a fan, go to our web site (fivetowns.maineadulted.org), click on the Like button and get our updates.