This will certify that I, and no one else, completed the on-line course known as:

The course is approved for hours of New York State continuing education credit.
The actual time spent on this course (a minimum of 90% of the accredited hours) is .

The course was completed on (month/day/year)

Student E-Mail Address

Student Name

Student Mailing Address

S11-Digit License Registration Number(Located on your DOS-issued Pocket Card)

Course Survey

The Instructor:	Low				High
Demonstrated knowledge of course content
Encouraged feedback and questions
Responded to my questions quickly
Instructor's support of student
Instructor/student interaction

Content/Materials:	Low				High	n/a
Orientation was thorough and clear
Organization of content
Course objectives clearly stated
Content was what I expected
Value of resource materials
Ease of use of software if CBT

Delivery Method:	Low				High	n/a
Satisfied with my learning experience
Course provided interactivity with instructor
Course provided interactivity with other students
Program met my needs
Degree of problems with self paced instruction
If this course utilized any technologies, such as the Internet or TV, please rate your satisfaction with the technologies

How was the orientation session accomplished?

If this was a pre or post license course, were you given either state exam information or original licensing information in the orientation session?

Who answered your questions regarding course content?

Were they able to sufficiently help you? If not, please explain.

What suggestions do you have to improve this program?

Student Signature
By clicking on "Send" below, you will be deemed to have signed the foregoing Student Completion Letter and Survey and acknowledge that this electronic signature is valid and binding. Specifically, you consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using any electronic service we offer, or in accessing or making any transactions regarding any agreement, acknowledgement, consent, terms, disclosures or conditions constitutes your signature, acceptance and agreement as if actually signed by you or writing. Further, you agree that no certification authority or other third party verification is necessary to the validity of your electronic signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract between you and WPAR.