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)
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
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)