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Origination Center*
If your origination center is not on the list, please add it here
Broadcast Title*
Broadcast Date*
Date Picker
Time of broadcast* eg: 1600
Did the broadcast begin at the scheduled time?* Yes
No - Delayed 5 minutes
No - Delayed 10 minutes
No - Delayed more than 10 minutes
Class cancelled
If delayed, what was the reason?
Did you experience technical problems?* Yes - Major disruption
Yes - Minor disruption
No
If you experienced technical difficulty, was it resolved satisfactorily? Yes
No
N/A
Were the educational objectives for this lesson achieved?* Yes
No
If not, what prevented achievement of objectives?
What is your level of satisfaction with interactive television?* 1 - Very satisfied
2 - Satisfied
3 - Dissatisfied
4 - Very dissatisfied
If dissatisfied, please let us know why
Please add other comments here
Name
Phone
Confirmation Code Enter this code in the field below:9553