Outreach Program HOST & Community Partner Feedback Form

Organization *

Your name *

Position *

Email *

I am submitting feedback for:

Dates of Programs *

Names of Muse staff, instructors or volunteers:

(Or general descriptions, if you can't remember names.)

The location of the program: *

How many participants attended the program? *

Please rate our professionalism *

	1	2	3	4	5
(1) Poor to (5) Excellent	1(1) Poor to (5) Excellent 1	2(1) Poor to (5) Excellent 2	3(1) Poor to (5) Excellent 3	4(1) Poor to (5) Excellent 4	5(1) Poor to (5) Excellent 5

Please rate the positivity of our impact on you or your group *

	1	2	3	4	5
(1) Poor (5) Excellent	1(1) Poor (5) Excellent 1	2(1) Poor (5) Excellent 2	3(1) Poor (5) Excellent 3	4(1) Poor (5) Excellent 4	5(1) Poor (5) Excellent 5

Would you recommend this program to another colleague? *

The BEST part about this program was: *

Something about this program that could be improved was: *

Additional Notes

Comments, questions, concerns, general musings... we love to hear your thoughts!

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