Client Evaluation Form
to be completed by the Client

Kentucky Peer Advisory Network
Grant Program

This Evaluation Form is used to gauge the effectiveness of the KPAN program and to measure the value of the service provided.

Please be as detailed as you can in your responses. THANK YOU!

This Evaluation Form should be completed by the President, Executive Director, Individual Artist or other key person who participated in the Kentucky Peer Advisory consultancy.

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PLEASE NOTE: While filling out the form below, DO NOT press the Enter/Return key as this will submit the form prematurely.

Fields designated with ** are required.

Client:	**
Contact Person:
Mailing Address:	**
City:	**    Zip+4:  **
County:	ADAIR ALLEN ANDERSON BALLARD BARREN BATH BELL BOONE BOURBON BOYD BOYLE BRACKEN BREATHITT BRECKINRIDGE BULLITT BUTLER CALDWELL CALLOWAY CAMPBELL CARLISLE CARROLL CARTER CASEY CHRISTIAN CUMBERLAND DAVIESS EDMONSON ELLIOTT ESTILL FAYETTE FLEMING FLOYD FRANKLIN FULTON GALLATIN GARRARD GRANT GRAVES GRAYSON GREEN GREENUP HANCOCK HARDIN HARLAN HARRISON HART HENDERSON HENRY HICKMAN HOPKINS JACKSON JEFFERSON JESSAMINE KENTON KNOTT KNOX LARUE LAUREL LAWRENCE LEE LESLIE LETCHER LEWIS LINCOLN LIVINGSTON LOGAN LYON MADISON MAGOFFIN MARION MARSHALL MARTIN MASON MCCRACKEN MCCREARY MCLEAN MEADE MENIFEE MERCER METCALFE MONROE MONTGOMERY MORGAN MUHLENBERG NELSON NICHOLAS OHIO OLDHAM OWEN OWSLEY PENDLETON PERRY PIKE POWELL PULASKI ROBERTSON ROCKCASTLE ROWAN RUSSELL SCOTT SHELBY SIMPSON SPENCER TAYLOR TODD TRIGG TRIMBLE UNION WARREN WASHINGTON WAYNE WEBSTER WHITLEY WOLFE WOODFORD
Daytime Phone:	**
FAX:
Email:	**
KPAN Advisor:
KPAN ADVISOR Please rate your experience of the following: (excellent, very good, fair, poor, n/a)   Excellent Very Good Fair Poor N/A  Peer Advisor's Preparation   Excellent Very Good Fair Poor N/A  Peer Advisor's Expertise   Excellent Very Good Fair Poor N/A  Peer Advisor's Responsiveness to the Client's Needs   Excellent Very Good Fair Poor N/A  Response and participation of people involved in consultancy   Excellent Very Good Fair Poor N/A  Accuracy and content of Peer Advisor's Final Report   Excellent Very Good Fair Poor N/A  Value of Peer Advisor's Assistance   Excellent Very Good Fair Poor N/A  Consultancy's Overall Effectiveness   Excellent Very Good Fair Poor N/A  Value of the Consultancy to you
What do you think was the most productive aspect of the consultancy? (Please limit answer to 500 characters or less)
What could have been better? How can we improve our services?  (Please limit answer to 500 characters or less)
Do you think the consultancy will help you achieve your goals?:  (Please limit answer to 500 characters or less)
EXPENSE REPORT Please tell us what the cost was to you to use the KPAN program. (Peer Advisors are supposed to bill client directly for their mileage and other expenses related to the consultancy. If you have not received an invoice from the Peer Advisor please indicate that below.)

Amount Paid to Peer Advisor for Mileage Expense?	$
Amount Paid to Peer Advisor for Lodging Expense?	$
Amount Paid to Peer Advisor for Meal Expense?	$
Amount Paid to Peer Advisor for Incidental Expenses?	$
TOTAL REIMBURSEMENT MADE TO PEER ADVISOR:	$
WE/I DID NOT RECEIVE AN INVOICE FROM THE PEER ADVISOR
In total, how many individuals from your organization or business participated in this consultancy?
How many are staff people?
How many are board members?
How many are volunteers?
May we send a copy of this evaluation to the KPAN Advisor?	YES      NO
Will you recommend the KPAN program to others?	YES      NO
Do you think you will request another KPAN?	YES      NO

 

Thank you for your interest in the work of the Kentucky Arts Council and support of the arts in Kentucky.      NOTE: You must press the Submit Button to send this form.

Kentucky Arts Council Home

 

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Kentucky Arts Council
500 Mero Street
21st Floor, Capital Plaza Tower
Frankfort, KY 40601
502-564-3757
Toll Free: 888-833-2787
FAX: 502-564-2839

Page Updated: 10/15/2007