\documentclass[12pt]{exam}
\usepackage{amssymb}

\usepackage{makeidx}
\begin{document}
\begin{center}
\textbf{Introduction to Linear Algebra}
\end{center}
\begin{center}
Feedback Form
\end{center}
\begin{center}
\vspace{0.1in}
\fbox{\fbox{\parbox{5.5in}{
Dear Participant\\Please invest some time to fill up this feedback form. You feedback is necessary to improve the future presentations. This form is anonymous, please do not put your name on this form.}}}
\end{center}
\vspace{0.1in}
\begin{questions}
\uplevel{Following are few questions regarding the skills of the speaker. Please fill the appropriate circle to rate: 1 being unsatisfactory and 5 being completely satisfied.}
\question The presenter's knowledge of the material discussed.
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\question The presenter's preparation and presentation of the material planned.
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\question The presenter's ability to answer questions and provide meaningful answers for the audience.
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\question The presenter ability to explain the subject by giving sufficient examples, visual aids and materials.
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\question The presenter's communication skills (including grammar).
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\end{questions}
\begin{questions}
\uplevel{Following are few questions regarding participant's understanding of the talk. Please fill the appropriate circle to rate: 1-nill, 2-marginal, 3,4-substantial and 5-quiet appreciable.}
\question Increase in your knowledge.
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\question Development of your interest in Linear Algebra (after the talk).
\begin{oneparcheckboxes}
\choice 1\choice 2\choice 3\choice 4\choice 5
\end{oneparcheckboxes}
\end{questions}
%\begin{questions}
\uplevel{Suggestions \& comments.}
%\question
%Suggestions for improvements.
\fillwithlines{2in}

%\end{questions}

\end{document}

The the output looks like this.