\documentclass[11pt]{article}
\usepackage[margin=1in]{geometry}
\usepackage{graphics}
\usepackage{latexsym}


\newcommand{\NAME}{INSERT YOUR NAME HERE!}
\newcommand{\TITLE}{INSERT TOPIC TITLE HERE!}

\newcommand{\CLASSNO}{566}
\newcommand{\CLASSNAME}{Computer Security}
\newcommand{\YEAR}{2012}
\newcommand{\DEPARTMENT}{Department of Computer Science}
\newcommand{\INSTITUTION}{University of Arizona}

\newcommand{\Smile}{\scalebox{0.6}{\includegraphics{tor/evalform/graphics/smile.eps}}}
\newcommand{\BigSmile}{\scalebox{0.6}{\includegraphics{tor/evalform/graphics/bigsmile.eps}}}
\newcommand{\Yell}{\scalebox{0.6}{\includegraphics{tor/evalform/graphics/yell.eps}}}
\newcommand{\Sad}{\scalebox{0.6}{\includegraphics{tor/evalform/graphics/sad.eps}}}
\newcommand{\Think}{\scalebox{0.6}{\includegraphics{tor/evalform/graphics/think.eps}}}

\newcommand{\ibox}[2]{
   \parbox[#2]{#1}{\fbox{\rule{0pt}{0.8cm}\rule{#1}{0pt}}}
}

\newcommand{\STUDENTINFO}{
   \begin{center}
   \begin{tabular}{lllp{5cm}}
   {\bf Presenters:} & \NAME & {\bf Topic:} & \TITLE
   \end{tabular}
   \end{center}
}

\newcommand{\EVAL}{
   \begin{tabular}{ccccccccccc}
    \Yell & & & & & \Think & & & & & \BigSmile \\
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ &
    $\Box$ \\
   \end{tabular}
}

\pagestyle{empty}
\begin{document}
\begin{center}
   {\bf\Large CSc \CLASSNO\  \YEAR --- \CLASSNAME \\[2mm]
            Evaluation of Presentation}
\end{center}
\bigskip
\bigskip

\thispagestyle{empty}

\begin{center}
\begin{tabular}{p{6cm}l}\hline
   \bf The presenter was well prepared (mastered the topic, made slides/handouts, practiced the talk)                & \EVAL \\\hline
   \bf The presenter made good use of slides, blackboard, computer  & \EVAL \\\hline
   \bf The presentation was well organized
       (introduction, subtopics, conclusion)                 & \EVAL \\\hline
   \bf The presentation had the right level of technical detail& \EVAL \\\hline
   \bf The presenter timed the presentation well                               & \EVAL \\\hline
   \bf The presenter spoke clearly and at the right pace                              & \EVAL \\\hline
   \bf Overall quality of presentation                    & \EVAL \\\hline
\end{tabular}
\end{center}

\bigskip

\begin{center}
\begin{tabular}{|p{14cm}|}
   \multicolumn{1}{c}{{\bf Comments to the Presenter}} \\ \hline
   \\[6cm]\hline
\end{tabular}
\end{center}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\hrulefill
\bigskip

\STUDENTINFO

\newpage 

\begin{center}
\begin{tabular}{|p{12cm}c|}
    \multicolumn{2}{c}{\bf Common Positive Feedback --- Tick All That Apply} \\\hline
   \bf Dude, totally excellent talk! Awesome!                           & $\Box$ \\\hline
   \bf Dude, I loved how you connected your topic to the ``big picture!'' & $\Box$ \\\hline
   \bf Dude, I actually wanted to listen to what you were saying --- you made a boring
       topic seem interesting!                                          & $\Box$ \\\hline
   \bf Dude, I loved your ideas on how the paper could have been improved! & $\Box$ \\\hline
   \bf Dude, I loved your examples! So much easier to understand a 10-line
       code sample than slides of text!                                 & $\Box$ \\\hline
   \bf Dude, I loved your figures! So much easier to understand than 
       slides of text!                                                  & $\Box$ \\\hline
\end{tabular}
\end{center}

\bigskip

\begin{center}
\begin{tabular}{|p{12cm}c|}
    \multicolumn{2}{c}{\bf Common Negative Feedback --- Tick All That Apply} \\\hline
   \bf Dude, you talk waaaay too fast!                                  & $\Box$ \\\hline
   \bf Dude, like there's too much stuff on your slides!                & $\Box$ \\\hline
   \bf Dude, I couldn't hear what you were saying! Speak up, yo!        & $\Box$ \\\hline
   \bf Dude, practice your talk next time, will ya!                     & $\Box$ \\\hline
   \bf Dude, talk to me, not the whiteboard!                            & $\Box$ \\\hline
   \bf Dude, too much technical detail --- I never got what was important about the paper!                & $\Box$ \\\hline
   \bf Dude, not enough detail - I learned like nuthin', dude!          & $\Box$ \\\hline
   \bf Dude, what about your own opinions? You never said what was
       good/bad about the paper!                                        & $\Box$ \\\hline
   \bf Dude, who are you? You never introduced yourself!                & $\Box$ \\\hline
   \bf Dude, what paper were you talking about? You never introduced the
       paper or the authors!                                            & $\Box$ \\\hline
\end{tabular}
\end{center}

\end{document}
