Please provide the name of the facilitator.*
Please select the program you are participating in.*
On a scale of 1 -10 with 1 being poor and 10 being excellent, how would you rate yourself on the following:  
1. The learning materials?

2. Yourself with regards completing homework (written, audio, online)?
3 . Yourself with regards to setting and achieving the goals you set?

4. The facilitator?
5. What new habits or skills have you developed?

6. What goals have you achieved and strategies have you implemented that were developed through the program?
4. Online learning rating

4 a. Comments regarding the online learning modules
7. How could we make this program even better for future participants?
8. What are your thoughts on the overall program?
6. Have you achieved goals and implemented strategies that you developed?
6. a) Please explain or provide examples of achieved goals or implemented strategies
7. How could we make the program even better for future participants?
Please analyze your participation in the program. On a scale of 1 -10, how would you rate yourself on the following: 
8. I read the materials as required.

9. I listened to the audio as required (if applicable).

10. I did the online modules (if applicable).

11. I set and achieved goals.

12. What other programs might be of interest to you?
12. a) Any other programs, please specify:
13. Would you recommend this program to others?
14. If yes you would recommend the program, may we call you to discuss?
Please include your name and phone number.
15. Other comments or suggestions: