This form is available electronically. Form Approved – OMB No. 0560-0237
FSA-2376 U.S. DEPARTMENT OF AGRICULTURE (12-31-07) Farm Service Agency
BORROWER TRAINING COURSE EVALUATION
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PART A – TO BE COMPLETED BY VENDOR |
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1. Course Title
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2. Instructor’s Name
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3. Vendor’s Name
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4. Vendor’s Address
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5. Date of Training Course
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6. Location
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PART B – TO BE COMPLETED BY BORROWER |
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1. The topics covered in class were helpful to me in my business……… |
Yes |
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Partially |
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No |
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11. Comments on the strong points of the course:
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2. The coverage of this subject matter was……………………………..…..… |
Excellent |
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Sufficient |
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Poor |
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3. The suitability of the instruction material was…………..……...…….…. |
Excellent |
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Sufficient |
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Poor |
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4. The level of the course was……….…. |
Too Advanced |
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Appropriate |
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Too Easy |
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5. The length of the course was……….. |
Too Long |
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Appropriate |
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Too Short |
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6. The amount of outside work was…….. |
Too Much |
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Appropriate |
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Too Little |
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12. Comments on the weak points of the course:
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7. The instructor was………………..….. |
Excellent |
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Good |
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Poor |
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8. The facilities were…………..……….… |
Excellent |
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Good |
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Poor |
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9. Will you continue to take training Courses in production and financial management if not required?.............. |
Yes |
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Maybe |
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No |
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10. Would you recommend this course to other individuals?............. |
Yes |
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No Comment |
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No |
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13(a). Signature (Optional)
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13(b). Date
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After you have completed this evaluation, please it to the Vendor. |
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NOTE: |
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated Farm and Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan, and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including your Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE. |
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
File Type | application/msword |
File Title | This form is available electronically |
Author | liz.ashton |
Last Modified By | maryann.ball |
File Modified | 2010-07-12 |
File Created | 2010-07-12 |