Fillable Form 14364 - Continuing Education Evaluation printable pdf download

Form 14364 - Continuing Education Evaluation

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Department of the Treasury - Internal Revenue Service

14364

Form

OMB Number

Continuing Education Evaluation

1545-1726

(January 2012)

Full name of CE Provider

Program name

IRS issued Program number

Date(s) program was delivered

Name of participant

Instructions: Answer the seven questions below to the best of your ability

to evaluate the program you completed. Assign a number grade using a

scale from 1 to 5 , with 1 being the lowest and 5 the highest.

If the question is not applicable, select NA.

Were stated learning objectives met

Were program materials accurate, relevant and did they contribute

to the achievement of the learning objectives

Was the time allotted to learning adequate

Were the facilities / equipment appropriate

Were the handout materials satisfactory

Were the audio and video materials effective

If applicable, were individual instructors knowledgeable and effective

Privacy Act and Paperwork Reduction Notice

We ask for the information on this form to carry out the laws of the United States. The primary purpose of this form is to evaluate the content and

delivery of our continuing education programs. We are requesting this information under authority of 26 U.S.C. § 7801 and § 7803 and 31 U.S.C. §

330. We use the information on this form to ensure that we are complying with the continuing education provider requirements in 31 C.F.R. part 10.

Providing this information is voluntary, and failure to provide all or part of the information will not affect you. We may disclose this information to a

contractor as necessary to perform the contract.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid

OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the

administration of any Internal Revenue law. The time require to complete this form will vary depending on individual circumstances. The estimated

average time is 15 minutes.

14364

Catalog Number 59126Z

Form

(1-2012)