Form 6494-06 Form 6494-06 Community Affairs Event Evaluation

OMB Number: 3064-0127

Expiration Date: 03/31/2017

Federal Deposit Insurance Corporation

Event Evaluation

INSTRUCTIONS: Please provide your feedback to help us evaluate today’s program and plan future events. If you would like to provide additional comments, please use the COMMENTS section on page 2.

EVENT TITLE: _ __________________________________________ DATE: ______________________
LOCATION OF EVENT: ________________________________________________________________

Please circle the applicable rating. Do not attempt to split a rating.

The session improved my understanding of the subject matter……..…………………………………………………………….	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree
The session helped to identify opportunities for my organization……………...……………………………………………..	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree
The session helped to identify potential partners for me……..…..	Very helpful	Helpful	Moderately helpful	Of little Help	Not Helpful
I would recommend this program to others in my position..……..	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree

Follow-Ups

Criteria	Yes	No
Would you be interested in a follow-up session on this topic?
Would you be interested in another meeting like this on another topic?
Please specify the topic of interest: __(drop down of ___________________________________________________________________­­ _______________________________________________________________________________________________________________________________________________________________________________

Please check the type of organization you represent

	Financial Institution		Non-Profit Organization		Foundation		Academic Institution		Government Agency
Other (Please specify)): _______________________________________________________________________________ __________________________________________________________________________________________________

1. What parts of this event did you find most valuable? ______________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

2. What is the most important thing that could be done to improve this event? ____________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

3. Please provide examples of how you may apply your knowledge from today’s program:

___________

COMMENTS:

OPTIONAL CONTACT INFORMATION (If you would like to contact us to discuss your suggestions, please call

_______________________________ at ________________________. If you would like for us to notify you of a follow-up session, provide your contact information below.)

Name: ___________________________________________________________________________________________

Organization: _____________________________________________________________________________________

Telephone Number (Include Area Code): _______________________________________________________________

E-Mail Address: ___________________________________________________________________________________

We thank you for your feedback.

PAPERWORK REDUCTION ACT NOTICE

Public reporting burden for this collection of information is estimated to average 5-7 minutes per response, including the time for completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the FDIC, Washington, DC 20429; and to the Office of Management and Budget, Paperwork Reduction Project (3064-0127), Washington, DC 20504.

FDIC 6494/06 (4-13) Page 1 (See Reverse for additional information)