COMMUNITY OUTREACH EVALUATION FORM

NAME OF THE ACTIVITY: ______________________________VENUE:______________DATE: ______________

OBJECTIVE:_________________________________________________________________________________
___________________________________________________________________________________________

NAME: _____________________________________________________
COURSE AND YEAR: ___________________________________________
COLLEGE/DEPT/OFFICE: ________________________________________

Instructions: This questionnaire is designed to evaluate ICES Community Outreach. Rate each item by checking
the level of satisfaction, appreciation and evaluation of the activities.

5- Excellent
4-Good
3-Average
2-Poor
1-Very Poor

LEVEL OF LEVEL OF IMPLEMENTATION

SATISFACTION/APPRECIATION

CRITERIA 1 2 3 4 5 1 2 3 4 5
I. OBJECTIVE

a) Awareness to the AdU

Vision-Mission
b) Alignment to the
University’s mission-vision
c) Awareness to the
College/Department
Vision-Mission
d) Alignment to the
Department’s
mission-vision
e) Addressed the actual need
of the community
II. ACTIVITY
a) Relevance to course
b) Importance to the
community

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 c) Promptness (starts and
ends on time)
d) Impact to the community
III. COMMUNITY
a) Meeting Community
expectations
b) Responsiveness and
Receptiveness of the
activity
c) Appreciation of the
benefits extended
d) Level of participation
e) Student participants
provided with enough
security
IV. PREPARATION and SUPPORT

a) Skills of the students on

the activity implemented
b) Sufficient information
from the community
c) Sufficient assistance from
the ICEs during the
preparation and approval
of the activity
V. VENUE

a) Conduciveness to the
participants
b) Appropriateness for the
type of activity
c) Sufficient assistance from
the community in the
preparation of the venue

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Part II

1. What did you learn during the activity?

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2. What are the strengths of the activity?

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3. What are the weaknesses of the activity?

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4. What Vincentian values did you get from the activity?

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5. What is the most important lesson you have learned in the activity?

a. As a Student
___________________________________________________________________________________________
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b. As a Filipino Citizen
___________________________________________________________________________________________
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 EVALUATION FORM

Direction: In relation to this program, respond to each item according how you would honestly and objectively
assess the activity. Please encircle the number that represents the closest to your opinion.

Poor Fair Good Very Good Excellent

Program Objectives
1. Clarity of objectives 1 2 3 4 5
2. Relevance of Objectives 1 2 3 4 5
3. Attainment of Objectives 1 2 3 4 5

Program Implementation
1. Evidence of Planning 1 2 3 4 5
2. Sequencing of Topics/Activities 1 2 3 4 5
3. Time Allotment of 1 2 3 4 5
Topics/Activities
4. Presentation of 1 2 3 4 5
Topics/Activities
5. Relevance of Topics/Activities 1 2 3 4 5
Materials
1. Packaging of Materials
2. Adequacy of Materials 1 2 3 4 5
3. Relevance of Material 1 2 3 4 5
1 2 3 4 5

Secretariat
1. Efficiency of services 1 2 3 4 5
2. Professional behavior 1 2 3 4 5

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Impact of Topic/Activity
● Which topic/activity do you find most helpful and least helpful?

Most Helpful
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________

Least Helpful
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________

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 _________________________________________
TITLE OF REFLECTION

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