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The Journey Back Annual Evaluation
15.
Default Section
1.
Please describe your role in using this tool.
Burn Center staff
Burn Foundation Staff
Teacher
Parent
Fire Service
Other (please specify)
2.
Please describe your satisfaction with The Journey Back Program and resources to assist school reentry after burn injury.
Very satisfied
Satisfied
Indifferent
Dissatisfied
Very dissatisfied
3.
Please estimate the total number of children you are helping with this tool on an annual basis. (For example one school reentry may reach 200 children)
None, I have it for reference only
30-60 children per year
61-100 children per year
101-500 children per year
501-1000 children per year
Other (please specify)
4.
Please describe the strongest aspect of The Journey Back as a school reentry tool.
5.
Please describe the weakest area, or subject in need of improvement for The Journey Back.
6.
Please mark what topics below would be helpful to you.
An online message board for networking
A training course for using school reentry techniques
Online educational modules related to school reentry
A toolbox of more resources to use in school reentry presentations
Periodic articles or bulletins with school reentry information
Other (please specify)
7.
Describe what is going well with your school reentry programs.
8.
Describe what is challenging for your school reentry programs.
9.
Is The Journey Back providing you the needed information to comfortably reintegrate a child back to school after a burn injury?
Yes
No
10.
Are you using the basic format of The Journey Back to reintegrate children with other diagnosis or traumatic experiences (other than burns) back to school?
Yes
No
11.
How did you hear about The Journey Back?
Internet
Conference/Trade Show
Burn Support News article/advertisement
Child Life Council advertisement
Word of Mouth
Other (please specify)
12.
Do you use/recommend your constituents use other Phoenix Society programs/services? Please mark all that apply.
Phoenix World Burn Congress
George Pessotti Scholarship Program
Phoenix SOAR
Burn Support Magazine
Chat
On-line Resource Center and Support Community
Behavioral & Enhancement Skills Training
Phoenix Educational Grant Program
Prevention and Advocacy
Other (please specify)
13.
Please share how The Journey Back has impacted you; how has it benefitted the work that you do?
14.
Please share any additional comments:
