ACTIVITY EVALUATION FORM FOR CALIFORNIA MCLE 11 Please complete and submit Provider Name: THE OTHER BAR Provider Phone No.: (626) 222-6299 Provider Address: www.otherbar.org Title of Activity: Ed Dilkes Ethics: Hiring Someone in Recovery Date of Offering: Location: Otherbar.org Name of Participant: Directions: On a scale of 1-5 (5 being the highest, best or most and 1 being the least, lowest or worst) rate by selecting the number reflecting your opinion. To what extent were your personal objectives satisfied? 54321 Comments: To what extent did the environment contribute to the learning experience? 54321 Comments: To what extent did the written materials contribute to the learning experience? 54321 Comments: To what extent were the objectives stated in the promotional literature or those stated at the beginning of the activity satisfied? 54321 Comments: To what extent did the activity contain significant current intellectual or practical content? 54321 Comments: Instructor's Name : Ed Dilkes Subject/Topic: Ed Dilkes Ethics: Hiring Someone in Recovery Overall Teaching Effectiveness 54321 Effectiveness of Teaching Methods 54321 Intellectual or Practical Content 54321 Comments: