Distance Learning Exit Survey Review and Implementation Form

eLearning Exit Survey Review and Implementation Form

Please complete this form after reviewing the Distance Learning Course Exit Survey results for your course(s). If you are completing this form in reference to more than one course or section of a course, please be sure to enter each course subject, catalog number and class number (* denotes required fields).

* Instructor:

* E-mail Address:

I have reviewed the results of the DL Exit Survey for:


Subject/Catalog Number (Example: ENC 1101) Class Number
(If reviewing more than one class of the same course, please list all class numbers in the field below, separated by a comma and a space. Example: 0000, 0001, 0002)

Based on the survey results, I find:

After reviewing the survey submissions, my overall impressions and/or general comments regarding the results are:

If a revision was indicated, please describe the areas where modifications are needed:

Plan for Improvement

Problem identification:

Strategy for improvement:


Measure results methodology:

Improve student outcomes:

Date for implementation of revisions:

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