BCC-LLUCH-Linda de Vries

Brain Cooling Course Evaluation:
Thank you for your time. This survey will only take you a FEW minutes to complete. Please note, that each individual requesting a Continuing Education Certificate must complete a separate evaluation form.
Hidden
Title*
Hidden
Module
Evaluate the Presentation Style and Content --*
Beyond the NICU -- Linda de Vries
Excellent Very Good Good Fair Poor
The instructor’s ability to explain was
The pace of the material presented was
The content was clear and easy to follow
The content was relevant to my daily practice

Evaluation of Learning Objective(s) --*

Rate how well the presentation met the following learning objectives.

	Excellent	Very Good	Good	Fair	Poor
Name at least two tools to use to predict neuro-developmental outcome in infants with HIE
Describe the developmental trajectory of a child with injury to the central grey nuclei or watershed area from the NICU till school age

Continuing Education & Certificate Information
Complete the information below to receive a certificate of Participation & Continuing Education. By entering your information below, you certify that you have personally watched all presentations and entered this information after doing so, and that you are submitting this form only for yourself.
Name*
First Last
Job Title/Credentials
Please provide your State License # (this will appear on the CE Certificate)*
Email*
Enter any other comments here. Thank you for your time!
Hidden
Course Code Prefix*

These numbers will show BEFORE the course code on the template.
Hidden
Template Color*

(Don't forget the #)
Hidden
Number of Units Earned*

(Example: 1 hour, 3 hours, 10 magic beans -- be sure to add the measurement)

LLUCH NICU Cooling Team Training

Optional Brain Cooling Course Evaluation

	Excellent	Very Good	Good	Fair	Poor
The instructor’s ability to explain was
The pace of the material presented was
The content was clear and easy to follow
The content was relevant to my daily practice