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 ParQ Fillable
AMOB Program Info Cover Sheet Fillable
AMOB Attendance Log – Fillable with Totals
AMOB First Session Survey Fillable
AMOB Last Session Survey Fillable
Online Tai Chi for Arthritis and Fall Prevention
TCA/FP Registration Form Fillable
TCA/FP Participant Agreement Par-Q Fillable
TCA/FP Program Info Cover Sheet Fillable
TCA/FP Attendance Log – Fillable with Totals
TCA/FP First Session Survey Fillable
TCA/FP Last Session Survey Fillable
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)
(New Translations Coming in 2020)
Spanish CDSME Participant Info Survey
Spanish Program Info Cover Sheet
Spanish CDSME Attendance Log
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)
A Matter of Balance Data Collection Forms
Participant Agreement and Par Q
Tai Chi for Arthritis and Falls Prevention Data Collection Forms
Tai Chi Class Info Cover Sheet