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The University of Iowa
Regional Autism Services Program
Child Health Specialty Clinic

Outcome Evaluation Form


The Autism Services Programís Consultant, Sue Baker, from Child Health Specialty Clinics at the University of Iowa is interested in how things are proceeding with you and your colleagues. We are interested in how strategies, techniques, information, etc. shared at our recent exchange have changed behaviors or learning for the student. Some time ago, Sue participated in a meeting with you and others regarding technical assistance in the area of autism. Your group may or may not have responded to suggestions shared regarding the student.

This form asks for your response to our interaction several months post meeting, subsequent action taken by your group, or asks for a few general details regarding the impact on improved services for children with autism.

This office would appreciate completing this evaluation form and submitting it. Your input will help provide support or reshaping of the Regional Autism Services Program funded by the Bureau of Children, Family, and Community Services at the Iowa Department of Education.

  1. Name (first and last) of the student receiving Technical Assistance Services:

  2. How have you integrated or acted upon any of the information shared with your professional practice?

  3. Are there any changes in childrenís program, behavior, or outcomes in their educational experience because of new strategies you are using (facilitated by our meeting or action you have taken since)?

  4. Have you shared any materials with other?

  5. What suggestions do you have to make interactions like what we had previously more helpful?

  6. Do you anticipate any further service from the Autism Services Program?


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