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\begin{document}
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     \rfoot{\Pisymbol{pzd}{229} Continues overleaf \Pisymbol{pzd}{229}}
     \afterpage{\rfoot{\small$\Box$~%
                       I have made more comments on the attached sheet(s)}}

   Today's Date: \underline{\hspace{30ex}}  %
   \hspace{5ex}                             %
   Course:       \underline{\hspace{30ex}}  
   \begin{center}
   {\bf\Large Mid-semester Teaching Assessment}
   \end{center}

    Please answer these questions carefully.  They will help your professor
    to help you better.  If you need more room to explain something you may
    use the space on the back of this page, or include an extra page of
    your own.

   \begin{enumerate}
     \item
           What new things do you think the professor should \emph{start}
           doing to help you learn the material better?
           
           \vspace{\fill}

     \item
           Are there any things that the professor does in class that
           they should \emph{stop} doing?

           \vspace{\fill}

  \newpage

     \item
           What things does the professor do in class that help you to
           learn the material and that they should \emph{continue} doing?

           \vspace{\fill}

     \item Something I do not quite understand yet is \ldots
          
           \vspace{\fill}

   \end{enumerate}

  % \hrulefill\\
  %   If you need more room to explain something please include extra paper.
\end{document}
