CAPS Group Feedback Form Question Title * 1. Group Information Name of Group Semester (e.g Fall 2018) Group Facilitators OK Question Title * 2. How did you hear about this group? Social Media University Health Services/Tang e-mail or newsletter UHS website Poster/flyer Part of a standing meeting/class Friend Recommendation of a healthcare provider Other (please specify) OK Question Title * 3. Did you sign up for group through the EmaiMeForm (self-referral)? Yes No OK Question Title * 4. Did you sign up for group via the eTang portal? Yes No OK Question Title * 5. Are you using other UHS services? Please check all that apply. Individual therapy, off-campus Individual therapy, CAPS Individual therapy, Social Services Another group therapy Health coaching Career counseling Other (please specify) OK Question Title * 6. How helpful was group in expanding your understanding of yourself? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 7. How helpful was group in increasing your understanding the challenges that you are facing? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 8. How helpful was the group in expanding your efforts to make changes? 0 Helpfulness 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 9. How likely are you to maintain these changes in the long-term? 0 Helpfulness 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 10. How helpful were the group leaders? 0 Helpfulness 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 11. What was most helpful about the group? OK Question Title * 12. What was least helpful about the group? OK Question Title * 13. In what ways was the virtual format meeting your mental health needs during the COVID-19 pandemic? OK Question Title * 14. What recommendations would you make regarding the program? OK Question Title * 15. What is your overall satisfaction about the group 0 Satisfaction 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 16. Are you a: Undergraduate Student Graduate Student Student Parent Cal Veteran OK Question Title * 17. Do you identify as formally incarcerated, former foster youth and/ or system-impacted? Yes No OK Question Title * 18. Are you in the 1st-generation in your family to attend college? Yes No OK Question Title * 19. Do you identify as low-Income, or have a Pell Grant or Dream Grant in your financial aid? Yes No OK Question Title * 20. Are you an international student? Yes No OK Question Title * 21. Are you transgender? Yes No OK Question Title * 22. Gender: Female Male Genderqueer Nonbinary Agender Genderflux Bigender Self-identify: OK Question Title * 23. Ethnicity (Check all that apply): African American/Black American Indian/Alaska Native Chinese/Chinese-American East Indian/Pakistani Filipino/Filipino-American Japanese/Japanese-American Korean/Korean-American Polynesian/Micronesian Vietnamese/Vietnamese-American Other Asian Mexican/Mexican-American/Chicano Middle-Eastern Puerto Rican Other Spanish/American/Latino Mixed Race Decline to Answer Self-identify: OK DONE