An initiative of The N.C. Center for Health & Wellness at UNC Asheville | Statement of Compassion & Inclusion

Program Forms

Virtual Delivery Forms

Fillable Surveys and Support Forms for Online Course Delivery. Please visit our Program Provider Resources and Covid-19 pages to find support material for delivering these programs online safely, and with fidelity.

Guidance for managing fillable online surveys —

Download and share the one-pager Using Fillable Portable Document Files for Survey Data Collection.

Online A Matter of Balance
Participant Agreement Par Q Fillable    (no change)
AMOB Program Info Cover Sheet Fillable   (7/29/21)
AMOB Attendance with TUG Fillable    (7/29/21)
AMOB Participant Info Form / First Session Survey Fillable    (7/29/21)
AMOB Post Session Survey Fillable    (7/29/21)

Online Tai Chi for Arthritis and Fall Prevention 
TCA/FP Registration Form Fillable    (no change)
Participant Agreement Par Q Fillable    (no change)
TCAFP Program Info Cover Sheet Fillable   (7/29/21)
TCAFP Attendance for Virtual Fillable with Totals    (7/29/21)
TCAFP Participant Info Form / First Session Survey Fillable   (7/29/21)
TCAFP Post Session Survey Fillable    (7/29/21)

Online CDSME Toolkit Forms

CDSME Cover Sheet Fillable Fields

CDSME Attendance Log Fillable Fields

CDSME Participant Pre-Survey Fillable Fields

CDSME Participant Post-Survey Fillable Fields 

 

Reports generated from data collection are valuable for everyone —  participants, community sites, funders and policymakers. These reports are helping the evidence-based movement not only locally in your own communities, but nationally.

Updated paperwork for Living Healthy with CDSME workshops

The Administration for Community Living and the Office of Management and Budget have updated the Chronic Disease Self-Management Education (CDSME) program forms. Please take ~4 minutes to review the updates and tips on how to fill them out. These forms are now required of all CDSME programs.

CDSME Forms Instruction Webinar

The following forms are required for all CDSME workshops (Program Information Cover Sheet, Attendance Log, and Participant Information Survey):

Program Information Cover Sheet  (updated January 2020)
CDSME Attendance Log (updated January 2020)
Participant Information Survey and Last Program Session Form  (updated January 2020)

Tipsheet for Collecting Data

 

Walk with Ease Paperwork

OsteoArthritis Action Alliance (OAAA) Walk With Ease Data Collection Packet

WWE Participant Information Form  (updated 1/15/2019)

WWE Attendance Log  (updated January 2020)

 WWE Participant Post Program Form   (updated 1/15/2019)

Fidelity Evaluation Checklist

Image result for walk with ease logo

 

A Matter of Balance Data Collection Forms

A Matter of Balance Logo
AMOB Participant Info Form / First Session Survey    (7/29/21)
AMOB Post Session Survey    (7/29/21)
AMOB Program Info Cover Sheet    (7/29/21)
AMOB Attendance with TUG    (7/29/21)
Participant Agreement and Par Q    (no change)

 

Tai Chi for Arthritis & Falls Prevention Data Collection Forms


TCAFP Participant Info Form / First Session Survey     (7/29/21)
TCAFP Post Session Survey     (7/29/21)
TCAFP Program Info Cover Sheet    (7/29/21)
TCAFP Attendance with TUG    (7/29/21)
Participant Agreement and Par Q    (no change)