CAPS Outreach Evaluation Form Survey

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."

	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

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

	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

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

CAPS Outreach Evaluation Form

Virtual Mental Health and Wellness

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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:

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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?