NAMI Peer-to-Peer Evaluation Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you participating in NAMI Peer-to-Peer (P2P) and taking the time to share your feedback. Your comments and suggestions will help improve the program.

State where you attended P2P *

City or town where you attended P2P *

NAMI Affiliate that sponsored your class *

NAMI Coastal Virginia

Other:

Month & Year you finished P2P *

Option 1

Because of the P2P course I just attended, I am better able to: *

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

N/A

Recognize the signs and symptoms of mental health conditions

Understand the type of services and supports I need

Understand what "recovery" means as it relates to mental health

Prevent crises that may result from symptoms of my condition

Manage the stresses and negative impacts my condition may cause

Access the care and support that I need

Based on the P2P course I just completed (check the appropriate box for each question) *

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

N/A

I see the symptoms of mental health conditions as separate from the person experiencing symptoms

I do not believe mental health conditions are my fault

I have a right and an obligation to actively engage and question my treatment provider

Please let us know the degree to which you agree or disagree with the following: *

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

N/A

This program was helpful for me

I have learned information that was new to me

The leaders of this program communicated effectively

The workbook was useful for me

I would recommend this program to others

Please share your comments regarding the leaders of your class

What personal changes have you made, or do you plan to make, as a result of participating in P2P?

Now that you have participated in P2P, what other information would be helpful for you?

What is one suggestion you have for making this program better?

Your AHA! Experience: Participants in our NAMI education courses often experience an AHA! moment in class. AHA! moments are when something from the course finally clicked for you. We would love to hear when the light bulb went on...so to speak.

Option 1

Clear selection

I am willing to have my responses and comments be used anonymously for research and marketing purposes *

Yes

Demographics

Please answer as many of the questions below as you are comfortable with to help us learn more about the participants in NAMI programs.

What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

Clear selection

What is your gender?

Male

Female

Other, or prefer not to answer

Clear selection

What is your race/ethnicity?

Asian/Pacific Islander

Black/African-American

Caucasian

Hispanic, Latino, or Spanish

Native American/Alaska Native

Other/Multi-Racial

Decline to respond

Clear selection

How did you find out about P2P?

Family member or friend

Health care provider

nami.org

NAMI publication

NAMI Affiliate website (e.g. namicoastalvirginia.org)

Local newspaper/advertisement

Other

Clear selection

Are you a member of NAMI?

Yes

No, but I intend to join

No, I am not planning to join at this time

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of NAMI Virginia Beach. Report Abuse

Forms