Support Group Evaluation Form

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(Insert Name) PROGRAM
Support Group Evaluation Form
1.
Which face best captures how you feel about this program overall?
(please mark an 'x' over your choice)
L
K
J
K?
What do you like best?
___________________________________________________
___________________________________________________
What do you like least?
___________________________________________________
___________________________________________________
2.
For each of the following statement please circle the response that best
reflects your feeling about that statement.
This program has made an important difference in my life
Strongly Agree
Agree
Disagree
Strongly Disagree
I feel welcome when I attend support group meetings
Strongly Agree
Agree
Disagree
Strongly Disagree
I have learned skills in this program that I use each day
Strongly Agree
Agree
Disagree
Strongly Disagree
I am a better parent as a result of this program
Strongly Agree
Agree
Disagree
Strongly Disagree
I felt safe when raising my point of view in meetings
Strongly Agree
Agree
Disagree
Strongly Disagree
I practice better nutrition as a result of this program
Strongly Agree
Agree
Disagree
Strongly Disagree
I am more aware of community service that can help me as a result of participating in this
program
Strongly Agree
Agree
Disagree
Strongly Disagree
(Insert Name) PROGRAM
Support Group Evaluation Form
1.
Which face best captures how you feel about this program overall?
(please mark an 'x' over your choice)
L
K
J
K?
What do you like best?
___________________________________________________
___________________________________________________
What do you like least?
___________________________________________________
___________________________________________________
2.
For each of the following statement please circle the response that best
reflects your feeling about that statement.
This program has made an important difference in my life
Strongly Agree
Agree
Disagree
Strongly Disagree
I feel welcome when I attend support group meetings
Strongly Agree
Agree
Disagree
Strongly Disagree
I have learned skills in this program that I use each day
Strongly Agree
Agree
Disagree
Strongly Disagree
I am a better parent as a result of this program
Strongly Agree
Agree
Disagree
Strongly Disagree
I felt safe when raising my point of view in meetings
Strongly Agree
Agree
Disagree
Strongly Disagree
I practice better nutrition as a result of this program
Strongly Agree
Agree
Disagree
Strongly Disagree
I am more aware of community service that can help me as a result of participating in this
program
Strongly Agree
Agree
Disagree
Strongly Disagree
3.
How relevant was the program to your experience with ____________?
(place an 'x' on the line below)
___________________________________________________
No at all
Somewhat
Very
Comments:
___________________________________________________
___________________________________________________
___________________________________________________
4.
How would you rate the way the way program staff (or volunteers) interacted
with participants?
(place an 'x' on the line below)
___________________________________________________
Very Poorly
Very well
Comments:
___________________________________________________
___________________________________________________
___________________________________________________
5.
Describe an experience that you have had since participating in the program
that you dealt with differently because of what you learned through this
program?
___________________________________________________
___________________________________________________
___________________________________________________
6.
How do you think we could we improve the program?
___________________________________________________
___________________________________________________
___________________________________________________
Thanks for helping us to assess and improve the program!!

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