Small Funding Grants for Pacific Initiatives
Reporting Template

Supporting Pacific Communities

Congratulations! Your activity has been delivered! The final step is to tell us how it went and what you found out along the way.

Please complete the following questionnaire and click on the 'DONE' button once finished. It should take approximately 5 minutes to complete all the questions.

If you need any assistance to complete this form, or have any questions please contact Nadine Milmine on Nadine.Milmine@pegasus.org.nz or 0274 621 262.

Fa’afetai tele lava (Thank you very much)

Question Title

* 1. Contact details:

Name of person completing the form:

Involvement in activity:

Contact phone number:

Contact email:

Question Title

* 2. Activity overview:

Name of activity:

Aims and objectives (what did you want to achieve):

Brief description of activity:

Activity delivery dates and duration:

Location and setting (where you delivered the activity)

Method of promotion (e.g. flyers, social media, word of mouth):

Equipment and resources used:

Question Title

* 3. How many people participated in the activity?

Less than 10

Between 10-20

Between 20-30

Between 30-40

More than 40

Comments

Question Title

* 4. Which Pacific peoples participated in your activity? (tick all that apply)

Samoan

Fijian

Cook Islands

Tongan

Niuean

Tokelauan

Other

Comments

Question Title

* 5. Which groups were represented? (tick all that apply)

Children

Families

Seniors/Matua

Young people

Women

Men

People with a health condition (e.g. diabetes, obesity, etc)

People who are not regularly active (e.g. less than 30 minutes of moderate physical activity, 5 days a week)

Other (please specify)

Question Title

* 6. What evaluation methods and tools did you use? (tick all that apply)

Feedback from participants

Surveys

Focus groups

Interviews with individual participants (success stories)

Participant evaluation tools like flipcharts or grids

Other

Please provide more detail about the methods and tools used:

Question Title

* 7. How successful was the activity at achieving your objectives?

Not at all

Somewhat

Moderately

Very

Extremely

Not at all

Somewhat

Moderately

Very

Extremely

What information did you collect to inform this conclusion?

Question Title

* 8. How satisified were the participants?

Not

Somewhat

Satisfied

Very

Extremely

Not

Somewhat

Satisfied

Very

Extremely

What information did you collect to inform this conclusion?

Question Title

* 9. Did the activity result in an increase in physical activity levels?

Not at all

Somewhat

Moderately

Very

Extremely

Not at all

Somewhat

Moderately

Very

Extremely

Please tell us how you recorded changes in physical activity levels:

Question Title

* 10. Please share a positive outcome that occurred as a result of this activity (e.g. healthy lifestyle changes, support to continue the activity, participation in other activities, improved health of participants etc)

Small Funding Grants for Pacific InitiativesReporting Template

Supporting Pacific Communities

Question Title

* 1. Contact details:

Question Title

* 2. Activity overview:

Question Title

* 3. How many people participated in the activity?

Question Title

* 4. Which Pacific peoples participated in your activity? (tick all that apply)

Question Title

* 5. Which groups were represented? (tick all that apply)

Question Title

* 6. What evaluation methods and tools did you use? (tick all that apply)

Question Title

* 7. How successful was the activity at achieving your objectives?

Question Title

* 8. How satisified were the participants?

Question Title

* 9. Did the activity result in an increase in physical activity levels?

Question Title

* 10. Please share a positive outcome that occurred as a result of this activity (e.g. healthy lifestyle changes, support to continue the activity, participation in other activities, improved health of participants etc)

Small Funding Grants for Pacific Initiatives
Reporting Template