MCOA Strengthening End-of-Life Conversations Data Collection

Thank you for hosting an MCOA Strengthening End-of-Life Program. If you would, please fill out the following form and data from the individual participant Program Evaluations so that we may continue to learn and share with other centers!

Council on Aging Host Site Information

Please complete this form with the contact information of the staff lead.

Name of COA/Senior Center

Staff Lead Name

First

Last

Staff Lead Email

Confirm Email

Date of Event

Please select the End of Life Program you held.

(s) What or

Total Number of Registered Participants.

Actual Number of Participants.

Participant Data

Please report and tabulate the data collected from the individual participant Program Evaluation Forms.

1. What made you decide to come to this program?

Copy and paste quotes from participant evaluation forms.

2. What was the most valuable part (s) of this program?

Copy and paste quotes from participant evaluation forms.

3. What was your biggest takeaway from this program?

Copy and paste quotes from participant evaluation forms.

Program Satisfaction Scores

Please indicate how many participants selected each response for the following question.

4. How satisfied were you with this program?

If no responses were collected for an option, please select 0.

Very Satisfied

Satisfied

Neutral

Dissatisfied

Very Dissatisfied

5. What suggestions do you have to improve this program?

Copy and paste quotes from participant evaluation forms.

Program Recommendation

Please indicate how many participants selected each response for the following question.

6. Would you recommend this program to others?

Yes

7. Other comments or suggestions?

Copy and paste quotes from participant evaluation forms.