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

Program Forms

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.
The forms below can be completed as a fillable PDF or they can be printed out to serve either virtual or in-person workshops.
Please contact healthyagingncinfo@gmail.com if you have any questions about the forms.

Leaders and Coaches:  Please print out the Program Forms Guidance Flowchart before beginning a workshop to assist you with data collection.

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

Health Coaching

Once assigned to a health coach, all forms will be administered through the Healthie Platform.

 

Fall Prevention Sample Workshop Flyer Templates

Personalize the flyers for your organization using a pdf editor.

Both AMOB and TCA / FP flyer templates in one file
AMOB sample flyer template, single
TCA / FP sample flyer template, single

For Word versions of the above flyers, please visit Provider Resources and type in the search term ‘flyer’.

A Matter of Balance
Participant Agreement Par Q Fillable
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)
AMOB Fidelity Checklist

Tai Chi for Arthritis and Fall Prevention 
TCA/FP Registration Form Fillable
Participant Agreement Par Q Fillable
TCA/FP 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)
TCAFP Fidelity Checklist

Walk With Ease
WWE Participant Information Form Fillable
WWE Attendance Log Fillable
WWE Post Program Form Fillable
WWE Fidelity Evaluation Checklist Form Fillable
Walk With Ease Fidelity Checklist

Chronic Disease Self-Management Education (CDSME) Programs
CDSME Cover Sheet Fillable Fields
CDSME Attendance Log Fillable Fields
CDSME Participant Pre-Survey Fillable Fields
CDSME Participant Post-Survey Fillable Fields
Tipsheet for Collecting Data
CDSME Fidelity Checklist

CDSME Forms Instruction Webinar