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Wellness Grant Exit Survey
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R.E.A.C.H.
I AM’s Wellness Grant
Wellness Grant Exit Survey
Wellness Grant Exit Survey
admin
2019-12-14T15:05:16-05:00
Wellness Grant Exit Survey
Name
*
First
Last
Please provide your telephone number or email address:
*
Please provide today's date for our records:
*
MM slash DD slash YYYY
Briefly describe the nature of the service for which the grant funding was used.
*
How did the grant funding help you reach your expected outcomes?
*
Please rank the following statements.
How helpful was this grant in supporting your health and wellness goals?
*
5- Extremely helpful
4-Somewhat helpful
3-Neither helpful or unhelpful
2-Somewhat unhelpful
1- Not at all helpful
To what degree did you meet your expected outcomes during the course of the grant period?
*
81%-100%
61%- 80%
41%- 60%
21%- 40%
0%- 20%
To what degree has participating in this grant enhanced your quality of life?
*
5- Greatly enhanced
4- Somewhat enhanced
3- Neither enhanced nor diminished
2- Somewhat diminished
1- Greatly diminished
How easy was the grant application process?
*
5- Extremely easy
4- Somewhat easy
3- Neutral
2- Somewhat difficult
1- Very difficult
From your experience, how easy did you find the reimbursement/payment process?
*
5- Very easy
4- Somewhat easy
3- Neutral
2- Somewhat difficult
1- Very difficult
Was the grant amount adequate to support you in your health/wellness pursuits?
*
Yes
No
Do have any suggestions for the wellness grant regarding the application process, the disbursement of funds, or grant guidelines/requirements?
*
Do you intend to apply for the grant if it is offered again in 2020?
*
Yes
No
I am unsure at this time.
As outlined in the terms and conditions of the grant application, the following elements needed to be met in order to be eligible for the next grant cycle. Please check the appropriate box if you believe you have satisfied these requirements.
I have participated in a minimum of one I AM activity or meeting in the course of the grant period.
*
Yes
No
I have participated in fundraising for I AM in some capacity, as outlined in the grant guidelines.
*
Yes
No
If you'd like to provide a testimonial to the benefits of this grant or any photos that can be used to support the program, please feel free to do so in the space provided below.
Testimonial:
Photos:
Max. file size: 256 MB.
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