CAPS Outreach Evaluation Form

Virtual Mental Health and Wellness

Please take a moment to evaluate the program/presentation you attended. Your feedback is important to us.

Please do not enter private health information in this anonymous survey; instead use the eTang patient portal (https://etang.berkeley.edu/) to discuss counseling or treatment issues with a healthcare provider or insurance specialist."

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* 1. What's the date of the program that you attended? (Please enter as mm/dd/yyyy)

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* 2. Was this session a:

Be Well at Work Workshop

Counseling and Psychological Services (CAPS) Workshop / Training

CAPS Healing / Wellness Circle

CAPS Let's Talk Consultation (1 on 1 session)

Exercise is Medicine (EIM) Workshop

Health Coaching Session

Health Promotion Workshop

Nutrition Counseling (1 on 1 session)

Nutrition Workshop

Physical Therapy Workshop

Other (Please specify below)

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* 3. If you marked "other," what is the name of the session that you attended?

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* 4. How did you hear about this activity?

Social Media

University Health Services / Tang email or newsletter

UHS website

Poster/flyer

Part of a standing meeting or class

Friend

Recommendation from a healthcare professional

Other (please specify)

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* 5. Please indicate the name(s) of the facilitator:

Alie, Laura

Amin, Sonia

Anderson, Adisa

Aranda, Elizabeth

Baillie, Jeanine

Barrios, Bianca

Bell, Sue

Blum, Sasha

Brown, Treajane

Capone, Don

CASTELLANOS MILLER, RAQUEL

Chan, Kin-Ming

Chaney, Elizabeth

Chang, Christine

Chiovarelli, Rich

Chung, Mar

Cohen, Aaron

Cornish, Peter

Davis III, Claytie

Du, Yi

EASTMAN, PAUL

Godinez, Andrea

GOITIA, DENISE

Goodman, Matt

Guthrie, Carrie

Honigman, Amy

Huynh, Kiet Duc

Jackson, Genee

Jones, Jai

KANNAN, MADELEINE

Landsbaum, Holly

Lee, Jeff

Lee, Joshua

Lee, Paige

Lee Tsugawa, Karen

Lin, Tiffany

MARTINEZ, ERLY

McLean, Chris

Medina, Cynthia

Meza, Daniel

Murarka, Kusha

Orozco, Veronica

PANYAWAI, ALYSSA

Pena, Diana

Quach, Lisa

RICE, JEVON

ROZIC, ZDRAVKO

SHIMAOKA, JUNICHI

TAYLOR, DARIUS

Tourek, Sam

WON, CHIYON

Zaruba, Linda

Zhou, Christine

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* 6. Are you an:

Undergraduate Student

Graduate Student

Parent of a Cal Student

Cal Faculty/Staff

Other

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* 7. Are you in the 1st generation in your family to attend college?

Yes

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* 8. Do you identify as low-Income, or have a Pell Grant or Dream Grant in your financial aid?

Yes

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* 9. Are you an international student?

Yes

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* 10. Gender:

Female

Male

Transgender

Genderqueer/Gender Fluid/Gender NonConforming

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* 11. 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

White/Caucasian

Decline to Answer

Other (please specify)

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* 12. Did you learn anything from this activity that will positively impact your life?

Definitely yes

Probably yes

Not sure

Probably not

Definitely not

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* 13. How effective was this program in:

	Very Effective	Mostly Effective	Somewhat Effective	Mostly Ineffective	Very Ineffective	N/A
Providing information that was relevant to you?	Providing information that was relevant to you? Very Effective	Providing information that was relevant to you? Mostly Effective	Providing information that was relevant to you? Somewhat Effective	Providing information that was relevant to you? Mostly Ineffective	Providing information that was relevant to you? Very Ineffective	Providing information that was relevant to you? N/A
Offering new skills that you can use in your daily life?	Offering new skills that you can use in your daily life? Very Effective	Offering new skills that you can use in your daily life? Mostly Effective	Offering new skills that you can use in your daily life? Somewhat Effective	Offering new skills that you can use in your daily life? Mostly Ineffective	Offering new skills that you can use in your daily life? Very Ineffective	Offering new skills that you can use in your daily life? N/A
Increasing your understanding of mental health issues	Increasing your understanding of mental health issues Very Effective	Increasing your understanding of mental health issues Mostly Effective	Increasing your understanding of mental health issues Somewhat Effective	Increasing your understanding of mental health issues Mostly Ineffective	Increasing your understanding of mental health issues Very Ineffective	Increasing your understanding of mental health issues N/A
Increasing your awareness of UC Berkeley Counseling and Psychological Services	Increasing your awareness of UC Berkeley Counseling and Psychological Services Very Effective	Increasing your awareness of UC Berkeley Counseling and Psychological Services Mostly Effective	Increasing your awareness of UC Berkeley Counseling and Psychological Services Somewhat Effective	Increasing your awareness of UC Berkeley Counseling and Psychological Services Mostly Ineffective	Increasing your awareness of UC Berkeley Counseling and Psychological Services Very Ineffective	Increasing your awareness of UC Berkeley Counseling and Psychological Services N/A
Demonstrating sensitivity to multicultural differences?	Demonstrating sensitivity to multicultural differences? Very Effective	Demonstrating sensitivity to multicultural differences? Mostly Effective	Demonstrating sensitivity to multicultural differences? Somewhat Effective	Demonstrating sensitivity to multicultural differences? Mostly Ineffective	Demonstrating sensitivity to multicultural differences? Very Ineffective	Demonstrating sensitivity to multicultural differences? N/A
Increasing your comfort in seeking counseling for yourself during times of need?	Increasing your comfort in seeking counseling for yourself during times of need? Very Effective	Increasing your comfort in seeking counseling for yourself during times of need? Mostly Effective	Increasing your comfort in seeking counseling for yourself during times of need? Somewhat Effective	Increasing your comfort in seeking counseling for yourself during times of need? Mostly Ineffective	Increasing your comfort in seeking counseling for yourself during times of need? Very Ineffective	Increasing your comfort in seeking counseling for yourself during times of need? N/A
Increasing your comfort in referring others (students) to counseling during their times of need?	Increasing your comfort in referring others (students) to counseling during their times of need? Very Effective	Increasing your comfort in referring others (students) to counseling during their times of need? Mostly Effective	Increasing your comfort in referring others (students) to counseling during their times of need? Somewhat Effective	Increasing your comfort in referring others (students) to counseling during their times of need? Mostly Ineffective	Increasing your comfort in referring others (students) to counseling during their times of need? Very Ineffective	Increasing your comfort in referring others (students) to counseling during their times of need? N/A

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* 14. Please rate your overall satisfaction with:

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Somewhat Dissatisfied	Dissatisfied	Extremely Dissatisfied
The Program:	The Program: Extremely Satisfied	The Program: Satisfied	The Program: Somewhat Satisfied	The Program: Somewhat Dissatisfied	The Program: Dissatisfied	The Program: Extremely Dissatisfied
The Presenter:	The Presenter: Extremely Satisfied	The Presenter: Satisfied	The Presenter: Somewhat Satisfied	The Presenter: Somewhat Dissatisfied	The Presenter: Dissatisfied	The Presenter: Extremely Dissatisfied

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* 15. Please indicate your preference (virtual vs. in-person) for this type of activity:

Strongly prefer virtual

Somewhat prefer virtual

No preference

Somewhat prefer in-person

Strongly prefer in-person

CAPS Outreach Evaluation Form

Virtual Mental Health and Wellness

Question Title

* 1. What's the date of the program that you attended? (Please enter as mm/dd/yyyy)

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* 2. Was this session a:

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* 3. If you marked "other," what is the name of the session that you attended?

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* 4. How did you hear about this activity?

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* 5. Please indicate the name(s) of the facilitator:

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* 6. Are you an:

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* 7. Are you in the 1st generation in your family to attend college?

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* 8. Do you identify as low-Income, or have a Pell Grant or Dream Grant in your financial aid?

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* 9. Are you an international student?

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* 10. Gender:

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* 11. Ethnicity (Check all that apply):

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* 12. Did you learn anything from this activity that will positively impact your life?

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* 13. How effective was this program in:

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* 14. Please rate your overall satisfaction with:

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* 15. Please indicate your preference (virtual vs. in-person) for this type of activity:

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* 16. In what ways is this virtual format meet your mental health needs during COVID-19?

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* 17. Any suggestions for improving this program, including topics/resources that will assist you in coping during the COVID-19 pandemic?

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* 18. Just a few more questions here (please click)--will take less than one minute!"