Strengthening End of Life Conversations Data Collection Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Host Site InformationName *FirstLastEmail *EmailConfirm EmailName of COA/Senior Center *Date of Event * program? held. Number Please select the End of Life Program you held. *--- Select Choice ---Let's Talk About It! Book Discussion SeriesLet's Talk About Death Over Dinner Book Discussion & Community Dinner based on the book Let's Talk About Death Over Dinner by Michael HebbLive Well. Age Well. Informational SeriesWhat Matters Most? Living with the end in mind . . . Tough and Tender ConversationsLet's Talk About Death . . . Pilot ProgramMovie and Discussion Program Pilot ProgramOther (write in below)Write in Program here. Total Number of Registered Participants. *Actual Number of Participants. *Participant DataPlease report and tabulate the data collected from the individual participant 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 *No *If no, why?Copy and paste quotes from participant evaluation forms. 7. Other comments or suggestions? *Copy and paste quotes from participant evaluation forms. Submit
