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* 1. School or organization name (optional)

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* 2. Name of individual entering data (optional)

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* 3. Type of professional

High school teacher

Student

Healthcare professional

University/college staff or professor

Community based organization staff

Other (please specify)

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* 4. Number of participants

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* 5. If you ran multiple groups at the same time, how many groups did you run?

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* 6. Venue (name of location where program was held)

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* 7. Location (City, State, Zip Code) of Venue

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* 8. Type of venue, of the following:

Public school

Private school

Charter school

College or university

Place of worship

Library

Counseling Center

Other community-based organization setting

Hotel

Other (please specify)

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* 9. What program format was utilized?

For sessions of one hour each

Six sessions of 45-minutes each

Peer-led program on college campus

Other (please specify)

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* 10. How many girls/women completed all sessions of the program?

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* 11. If you offered the Body Project at school, what time of day did you run the program? Please check all that apply.

Lunch period

During class

Before school

After school

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* 12. Please rate the quality of the program with 1 being poor and 5 excellent:

	Poor				Excellent
Flow of sessions	Flow of sessions Poor	Flow of sessions	Flow of sessions	Flow of sessions	Flow of sessions Excellent
Time per session	Time per session Poor	Time per session	Time per session	Time per session	Time per session Excellent
Room/space	Room/space Poor	Room/space	Room/space	Room/space	Room/space Excellent
Group partcipation	Group partcipation Poor	Group partcipation	Group partcipation	Group partcipation	Group partcipation Excellent
Tone/environment	Tone/environment Poor	Tone/environment	Tone/environment	Tone/environment	Tone/environment Excellent
Preparedness to lead	Preparedness to lead Poor	Preparedness to lead	Preparedness to lead	Preparedness to lead	Preparedness to lead Excellent

Comments:

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* 13. Did participants appear to learn new information in the Body Project workshop?

Yes

Comments:

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* 14. Was there anything that came up during the session that you felt unprepared to address?

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* 15. After running the entire program, are there any topics, activities, or other components (i.e., team-building, parent involvement, etc.) that you would add to the program?

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* 16. If there was an extended body acceptance program (i.e., over the course of a semester), would you be interested in bringing that to your school?

Yes

Undecided

Why or Why Not?

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* 17. How likely do you think participants are to resist societal beauty ideals after completing this program?

Extremely likely

Likely

Neutral

Unlikely

Extremely unlikely

Comments:

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* 18. Did the program, as written, address the beauty ideals and concerns of your group of students?

Yes

Undecided

Comments:

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* 19. How did you tailor the program to meet the unique needs of your participants? What types of adaptations would you make to future versions of the program/script in order to be more effective in addressing body concerns & ideals of diverse populations?

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* 20. Rate the importance of each discussion/exercise:

	Not important	Slightly important	Moderately important	Important	Very important
Learning about the origin and costs of the appearance-ideal	Learning about the origin and costs of the appearance-ideal Not important	Learning about the origin and costs of the appearance-ideal Slightly important	Learning about the origin and costs of the appearance-ideal Moderately important	Learning about the origin and costs of the appearance-ideal Important	Learning about the origin and costs of the appearance-ideal Very important
Writing a letter to a younger girl who is struggling with body image concerns	Writing a letter to a younger girl who is struggling with body image concerns Not important	Writing a letter to a younger girl who is struggling with body image concerns Slightly important	Writing a letter to a younger girl who is struggling with body image concerns Moderately important	Writing a letter to a younger girl who is struggling with body image concerns Important	Writing a letter to a younger girl who is struggling with body image concerns Very important
Looking at yourself in the mirror and writing down all your positive qualities	Looking at yourself in the mirror and writing down all your positive qualities Not important	Looking at yourself in the mirror and writing down all your positive qualities Slightly important	Looking at yourself in the mirror and writing down all your positive qualities Moderately important	Looking at yourself in the mirror and writing down all your positive qualities Important	Looking at yourself in the mirror and writing down all your positive qualities Very important
Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine)	Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine) Not important	Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine) Slightly important	Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine) Moderately important	Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine) Important	Completing the checklist of appearance-ideal behaviors you engaged in over the last few years (i.e., purchased a fashion magazine) Very important
Role-playing comebacks to negative body statements	Role-playing comebacks to negative body statements Not important	Role-playing comebacks to negative body statements Slightly important	Role-playing comebacks to negative body statements Moderately important	Role-playing comebacks to negative body statements Important	Role-playing comebacks to negative body statements Very important
Writing a letter to someone who made comments about your appearance	Writing a letter to someone who made comments about your appearance Not important	Writing a letter to someone who made comments about your appearance Slightly important	Writing a letter to someone who made comments about your appearance Moderately important	Writing a letter to someone who made comments about your appearance Important	Writing a letter to someone who made comments about your appearance Very important
Challenging yourself to do things you don't normally do because of body image concerns	Challenging yourself to do things you don't normally do because of body image concerns Not important	Challenging yourself to do things you don't normally do because of body image concerns Slightly important	Challenging yourself to do things you don't normally do because of body image concerns Moderately important	Challenging yourself to do things you don't normally do because of body image concerns Important	Challenging yourself to do things you don't normally do because of body image concerns Very important
Engaging in activities that teach others how to resist or avoid the appearance-ideal	Engaging in activities that teach others how to resist or avoid the appearance-ideal Not important	Engaging in activities that teach others how to resist or avoid the appearance-ideal Slightly important	Engaging in activities that teach others how to resist or avoid the appearance-ideal Moderately important	Engaging in activities that teach others how to resist or avoid the appearance-ideal Important	Engaging in activities that teach others how to resist or avoid the appearance-ideal Very important
Writing a letter to your younger self on how to avoid developing body image concerns	Writing a letter to your younger self on how to avoid developing body image concerns Not important	Writing a letter to your younger self on how to avoid developing body image concerns Slightly important	Writing a letter to your younger self on how to avoid developing body image concerns Moderately important	Writing a letter to your younger self on how to avoid developing body image concerns Important	Writing a letter to your younger self on how to avoid developing body image concerns Very important
Discussing the benefits of the program and body activism	Discussing the benefits of the program and body activism Not important	Discussing the benefits of the program and body activism Slightly important	Discussing the benefits of the program and body activism Moderately important	Discussing the benefits of the program and body activism Important	Discussing the benefits of the program and body activism Very important
Writing about various ways in which the mass media promotes the appearance-ideal	Writing about various ways in which the mass media promotes the appearance-ideal Not important	Writing about various ways in which the mass media promotes the appearance-ideal Slightly important	Writing about various ways in which the mass media promotes the appearance-ideal Moderately important	Writing about various ways in which the mass media promotes the appearance-ideal Important	Writing about various ways in which the mass media promotes the appearance-ideal Very important
Engaging in group activities that teach others how to resist or avoid the appearance-ideal	Engaging in group activities that teach others how to resist or avoid the appearance-ideal Not important	Engaging in group activities that teach others how to resist or avoid the appearance-ideal Slightly important	Engaging in group activities that teach others how to resist or avoid the appearance-ideal Moderately important	Engaging in group activities that teach others how to resist or avoid the appearance-ideal Important	Engaging in group activities that teach others how to resist or avoid the appearance-ideal Very important

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* 21. What was the most effective part of this program?

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* 22. What did you like least about this program?

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* 23. The Body Project encourages active participation. Please describe any challenges you encountered in fostering individual/group participation.

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* 24. Is there anything facilitators can/should do to increase active participation?

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* 25. Has the Body Project affected your feelings toward your own body?

Yes

Undecided

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* 26. How likely are you to run this program again?

Extremely likely

Likely

Undecided

Unlikely

Extremely unlikely

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* 27. How will you continue to promote the messages of the Body Project in your school community? What opportunities/resources do students have to continue these conversations?

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* 28. Would you like to share any additional thoughts about the Body Project?

Please email ckronengold@myneda.org with any photos from the program, or post-program acts of body activism and other events, activities, and/or meetings.

Thank you for your time and insight!