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Feedback Forms

Discussion Leader Evaluation

Stations, organizations, discussion leaders, and participants, please give us your feedback.

Please print this form and return it by mail or fax to: Lennie Duensing, Associate Director of Outreach, Thirteen/WNET, 356 West 58th St., New York, NY 10019. Fax: 212-560-6992.

Neither wNetStation nor PBS Online is collecting these evaluation forms via the Internet.

Outreach Report
Discussion Group Leader Evaluation




1) Did you watch the BEFORE I DIE: MEDICAL CARE AND PERSONAL CHOICES broadcast with a group? How many people attended?

2) What responses did you receive from your group about the BEFORE I DIE: MEDICAL CARE AND PERSONAL CHOICES broadcast?

3) What did your group find most interesting about the broadcast?

4) What positive feedback did you receive?

5) Were there criticisms of the broadcast?

6) If so, how did you handle them?

7) Did you continue your discussion groups after the broadcast?

8) Did you plan any other activities after the broadcast?

9) How many people participated?

10) Did any of your discussion groups turn into social gatherings? For instance, did anyone gather at a coffee house to hold your discussion groups? Did you plan any other types of creative activities?

11) Did you always have a group leader?

12) Did she/he emerge or was this the person that put the group together?

13) What were some of the resource materials used?

14) Did the viewer's guide help you?

15) Did you order either of the two available tapes of the broadcast?

16) How useful were these? If you ordered the segmented version, was this particularly helpful? Was the Resource Kit a great tool?

17) What were some of the interesting dialogue developments?

18) What were some of the themes discussed?

19) Did everyone actively participate?

20) Did all participants fully listen to everyone else?

21) Do you have any comments/ suggestions?

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