UPDATED NWSRA Virtual 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 Virtual Program are you evaluating?

General Recreational Therapy Programming

Collaborative Programming (PURSUIT/STAR Academy/SibShops)

Clubs and Special Events

Activity Center

Weekly 1:1 Zoom and/or Phone Calls

NWSRA Bus Visits

Activity Box

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* 8. What is the specific program name?

Program Name

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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
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
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
Length of program season	Length of program season 3	Length of program season 2	Length of program season 1	Length of program season 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
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. Please list specific benefits received from participation in this Virtual Program:

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* 13. Suggestions to improve this Virtual Program:

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* 14. Do you have any suggestions for new Virtual Program ideas?

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* 15. Do you have any suggestions for new Activity Center 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 Virtual Programs 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

UPDATED NWSRA Virtual 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?

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

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* 6. What is today's date?

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* 7. What type of Virtual Program are you evaluating?

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* 8. What is the specific program name?

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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. Please list specific benefits received from participation in this Virtual Program:

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* 13. Suggestions to improve this Virtual Program:

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* 14. Do you have any suggestions for new Virtual Program ideas?

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* 15. Do you have any suggestions for new Activity Center 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 Virtual Programs 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: