Copper Beech Institute Public Program Survey We would be deeply grateful if you shared your experience with us. Thank you for helping us evaluate our programs and shape the future of our offerings. Approximately 2 minutes to complete. OK Question Title * 1. Program Name and Date OK Question Title * 2. Please rate your overall experience of the program Excellent Above Average Average Poor OK Question Title * 3. I felt safe in the space during the program. Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Other (please specify) OK Question Title * 4. After this program, I am better equipped to respond to stress. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 5. When faced with distractions, I am more prepared to maintain focus. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 6. I am more resilient and better equipped to bounce back from challenges. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 7. How likely is it that you would recommend Copper Beech to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 8. Additional Comments OK Question Title * 9. We invite you to share your name and email to join our community and stay connected. Name Email OK The following questions are completely optional. All of your individual information will be aggregated anonymously for reporting purposes and to help us understand representation and inclusivity at Copper Beech. We acknowledge that this language is continually evolving, so if there is new/better language for any of these identities that you feel should be included, please contact us at info@copperbeechinstitute.org. OK Question Title * 10. Gender Female Non-binary Trans Two Spirit Male I prefer not to answer A gender not described here: OK Question Title * 11. Do you self-identify as BIPOC? Yes BIPOC No BIPOC I prefer not to answer OK Question Title * 12. Describe your ethnic group or race: [small text box] OK Question Title * 13. Sexual Orientation Lesbian Gay Bisexual Queer Asexual Straight I prefer not to answer A sexual orientation not described here: OK Question Title * 14. Are you a current or former member of the U.S. Armed Forces, Reserves or National Guard? Yes No I prefer not to answer OK DONE