ThankyouforshowingHolesIntheMitteninyourororganizationWeappreciateyour feedbackonthevideosandthetoolkitThisinformationwillhelpusrevisethetoolkitandmeetyourneeds whendevelopingfuturematerialsThankyouPl ID: 893841
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1 Thank you for showing "Holes I
Thank you for showing "Holes In the Mitten" in your community or organization! We appreciate your feedback on the videos and the toolkit. This information will help us revise the toolkit and meet your needs when developing future materials. Thank you! Please fill in the blanks and circle answers where appropriate. Mail/ Email Facilitator Feedback Form and any other surveys to: HDRMHS , 3056 W. Grand Blv d. , Ste. 3 - 150, Detroit, MI 48202. Email:colormehealthy@michigan.gov Name : -------------------- Organization/Title : _ Ema i I : Phone : Event Date : _ Event Location : ---------------------- 1. Please tell us about your audience : # o f Participants : Description of Participants (ex. Community members, government staff, policy makers, etc. ) 2. What was the focus of this training ? (I.e. General Social Determinants, Food Access , Infant Mortality, etc.): -------------------------------------- 3. Which video (s) did your audience watch? All of the videos Overview We Eat Where We Are _Education Inequality Stress _One Size Does Not Fit All, Pt 1 _One Size Does Not Fit All, Pt 2 4. Did you feel adequately prepared as a facilitator? Very Poorly Prepared 1 2
2 Somewhat Prepared 3 4 Very
Somewhat Prepared 3 4 Very Prepared 5 5. How helpful was the facilitator guide in your preparation ? Not Very Helpful 1 2 Somewhat Helpful 3 4 Very Helpful 5 6. Overall, how do you feel that you performed as a facilitator? Not Very Well 1 2 Somewhat Well 3 4 Very Well 5 7. How appropriate was the content for the audience? Not Appropriate 1 2 Somewhat Appropriate 3 4 Very Appropriate 5 8. Based on your answer above , if your answer was " Not Appropriate ", can you explain why? 9. Overall, what was the audience reaction to the videos? Poor 1 2 Neutral 3 4 Excellent 5 10. Did issues arise during the discussion or presentation that you felt unprepared for? If so, please describe them. 11. Would you use the videos again in the future? No Probably 1 2 Definitely 3 12. Were you easily able to adapt the materials in the toolkit to fit your needs? Yes No 13. How would you rate the activities and icebreakers? Not Engaging 1 2 Somewhat Engaging 3 4 Very Engaging 5 14. Would you recommend this toolkit to others? Yes No Additional comments or recommendations?