1. Name:    First:     Last:

2. E-mail: 

3. URL of site/page(s) visited:  

4. Time in minutes spent on URL:  

5. Date you completed educational material at this URL:   (MM/DD/YYYY)

6. Comments regarding relevance to learning goals (e.g., this site met my needs):

7. I would recommend this site to others in my field:
      Yes     No

Accuracy and Content:

8. Could you readily ascertain who authored the site/page?
      Yes     No

9. Did you see evidence that author(s) cited relevant literature to support information presented?
      Yes     No

10. Was it clear to you who funded the site/page(s) (e.g., for-profit company, university, government agency, etc.)?
      Yes     No

11. What year were the pages of educational material you reviewed dated?
(If date is not available - leave blank or put 'not available'):   (MM/DD/YYYY)