NWSRA In Person Program Evaluation Survey

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* 1. What is your name? (person filling out evaluation) - OPTIONAL

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* 2. What is the participant's name? - OPTIONAL

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* 3. What is your contact information? (phone/email) - OPTIONAL

Phone Number

Email Address

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* 4. Would you like to be contacted in regards to your evaluation?

Yes

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* 5. If yes, how would you like to be contacted?

Phone

N/A

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* 6. What is today's date?

Please select:

Date

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* 7. What type of program are you evaluating?

Club

Camp

General Recreational Therapy

Special Event

Pursuit Adult Day Program

STAR Academy

Other (please specify)

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* 8. What is the program name and number?

Program Name

Program Number

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* 9. Who is the program leader/coordinator?

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* 10. Program Information. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

	3	2	1	N/A
Program registration process efficiency	Program registration process efficiency 3	Program registration process efficiency 2	Program registration process efficiency 1	Program registration process efficiency N/A
Customer service during the registration process	Customer service during the registration process 3	Customer service during the registration process 2	Customer service during the registration process 1	Customer service during the registration process N/A
Location of program	Location of program 3	Location of program 2	Location of program 1	Location of program N/A
Program facility	Program facility 3	Program facility 2	Program facility 1	Program facility N/A
Time of program	Time of program 3	Time of program 2	Time of program 1	Time of program N/A
Day of program	Day of program 3	Day of program 2	Day of program 1	Day of program N/A
Description of the program in the brochure was met	Description of the program in the brochure was met 3	Description of the program in the brochure was met 2	Description of the program in the brochure was met 1	Description of the program in the brochure was met N/A
Goals listed in the brochure were met	Goals listed in the brochure were met 3	Goals listed in the brochure were met 2	Goals listed in the brochure were met 1	Goals listed in the brochure were met N/A
Activities were age appropriate	Activities were age appropriate 3	Activities were age appropriate 2	Activities were age appropriate 1	Activities were age appropriate N/A
Communication of schedule/activities	Communication of schedule/activities 3	Communication of schedule/activities 2	Communication of schedule/activities 1	Communication of schedule/activities N/A
Length of program (weeks)	Length of program (weeks) 3	Length of program (weeks) 2	Length of program (weeks) 1	Length of program (weeks) N/A
Overall satisfaction of the program	Overall satisfaction of the program 3	Overall satisfaction of the program 2	Overall satisfaction of the program 1	Overall satisfaction of the program N/A

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* 11. Program leader/coordinator. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

	3	2	1	N/A
Prompt/Dependale	Prompt/Dependale 3	Prompt/Dependale 2	Prompt/Dependale 1	Prompt/Dependale N/A
Communication	Communication 3	Communication 2	Communication 1	Communication N/A
Friendly attitude	Friendly attitude 3	Friendly attitude 2	Friendly attitude 1	Friendly attitude N/A
Enthusiasm	Enthusiasm 3	Enthusiasm 2	Enthusiasm 1	Enthusiasm N/A
Professionalism	Professionalism 3	Professionalism 2	Professionalism 1	Professionalism N/A
Preperation and Instruction	Preperation and Instruction 3	Preperation and Instruction 2	Preperation and Instruction 1	Preperation and Instruction N/A
Ability to adapt activities	Ability to adapt activities 3	Ability to adapt activities 2	Ability to adapt activities 1	Ability to adapt activities N/A
Encouraged independence	Encouraged independence 3	Encouraged independence 2	Encouraged independence 1	Encouraged independence N/A
Overall satisfaction of their performance	Overall satisfaction of their performance 3	Overall satisfaction of their performance 2	Overall satisfaction of their performance 1	Overall satisfaction of their performance N/A

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* 12. Assisting staff. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

	3	2	1	N/A
Prompt/Dependable	Prompt/Dependable 3	Prompt/Dependable 2	Prompt/Dependable 1	Prompt/Dependable N/A
Communication	Communication 3	Communication 2	Communication 1	Communication N/A
Friendly attitude	Friendly attitude 3	Friendly attitude 2	Friendly attitude 1	Friendly attitude N/A
Enthusiasm	Enthusiasm 3	Enthusiasm 2	Enthusiasm 1	Enthusiasm N/A
Professionalism	Professionalism 3	Professionalism 2	Professionalism 1	Professionalism N/A
Preperation/Instruction	Preperation/Instruction 3	Preperation/Instruction 2	Preperation/Instruction 1	Preperation/Instruction N/A
Ability to adapt activities	Ability to adapt activities 3	Ability to adapt activities 2	Ability to adapt activities 1	Ability to adapt activities N/A
Encouraged independence	Encouraged independence 3	Encouraged independence 2	Encouraged independence 1	Encouraged independence N/A
Overall satisfaction of their performance	Overall satisfaction of their performance 3	Overall satisfaction of their performance 2	Overall satisfaction of their performance 1	Overall satisfaction of their performance N/A

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* 13. Please list specific benefits received from participation in this program:

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* 14. Suggestions to improve this program:

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* 15. Do you have any suggestions for new activities?

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* 16. With 1 being the least likely and 10 being the most likely, how likely are you to recommend NWSRA programs and services to others?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 17. Would you like to be added to the NWSRA email list for updates on the most current information?

Yes

Already receiving e-mail updates

NWSRA In Person Program Evaluation

Question Title

* 1. What is your name? (person filling out evaluation) - OPTIONAL

Question Title

* 2. What is the participant's name? - OPTIONAL

Question Title

* 3. What is your contact information? (phone/email) - OPTIONAL

Question Title

* 4. Would you like to be contacted in regards to your evaluation?

Question Title

* 5. If yes, how would you like to be contacted?

Question Title

* 6. What is today's date?

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* 7. What type of program are you evaluating?

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* 8. What is the program name and number?

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* 9. Who is the program leader/coordinator?

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* 10. Program Information. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

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* 11. Program leader/coordinator. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

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* 12. Assisting staff. Please select the appropriate ranking for each question. 3 = Exceeds Expectations, 2 = Meets Expectations, 1 = Not Adequate, N/A = Not Applicable

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* 13. Please list specific benefits received from participation in this program:

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* 14. Suggestions to improve this program:

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* 15. Do you have any suggestions for new activities?

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* 16. With 1 being the least likely and 10 being the most likely, how likely are you to recommend NWSRA programs and services to others?

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* 17. Would you like to be added to the NWSRA email list for updates on the most current information?

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* 18. If you answered yes to the above question, please enter your email address below: