Hampton Integrated Wellness - Boris Lawrence Henson Foundation

Student ID

Name

First

Last

Email Address

Date of Birth

Self-Identified Gender

Program Attended

Session Date

Date

Time

Please rate your level of satisfaction with the following aspects of this program:

	Very Satisfied	Satisfied	Neutral	Unsatisfied	Very Unsatisfied
Program Organization	Very SatisfiedProgram Organization Very Satisfied	SatisfiedProgram Organization Satisfied	NeutralProgram Organization Neutral	UnsatisfiedProgram Organization Unsatisfied	Very UnsatisfiedProgram Organization Very Unsatisfied
Facilitators	Very SatisfiedFacilitators Very Satisfied	SatisfiedFacilitators Satisfied	NeutralFacilitators Neutral	UnsatisfiedFacilitators Unsatisfied	Very UnsatisfiedFacilitators Very Unsatisfied
Facility/Physical Environment	Very SatisfiedFacility/Physical Environment Very Satisfied	SatisfiedFacility/Physical Environment Satisfied	NeutralFacility/Physical Environment Neutral	UnsatisfiedFacility/Physical Environment Unsatisfied	Very UnsatisfiedFacility/Physical Environment Very Unsatisfied
Content of Program	Very SatisfiedContent of Program Very Satisfied	SatisfiedContent of Program Satisfied	NeutralContent of Program Neutral	UnsatisfiedContent of Program Unsatisfied	Very UnsatisfiedContent of Program Very Unsatisfied
Length/Duration of the Program	Very SatisfiedLength/Duration of the Program Very Satisfied	SatisfiedLength/Duration of the Program Satisfied	NeutralLength/Duration of the Program Neutral	UnsatisfiedLength/Duration of the Program Unsatisfied	Very UnsatisfiedLength/Duration of the Program Very Unsatisfied
Program Meeting Your Needs/Expectations	Very SatisfiedProgram Meeting Your Needs/Expectations Very Satisfied	SatisfiedProgram Meeting Your Needs/Expectations Satisfied	NeutralProgram Meeting Your Needs/Expectations Neutral	UnsatisfiedProgram Meeting Your Needs/Expectations Unsatisfied	Very UnsatisfiedProgram Meeting Your Needs/Expectations Very Unsatisfied

Please identify how much you agree with the following statements:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The program met my needs	Strongly DisagreeThe program met my needs Strongly Disagree	DisagreeThe program met my needs Disagree	NeutralThe program met my needs Neutral	AgreeThe program met my needs Agree	Strongly AgreeThe program met my needs Strongly Agree
I feel encouraged after attending this program	Strongly DisagreeI feel encouraged after attending this program Strongly Disagree	DisagreeI feel encouraged after attending this program Disagree	NeutralI feel encouraged after attending this program Neutral	AgreeI feel encouraged after attending this program Agree	Strongly AgreeI feel encouraged after attending this program Strongly Agree
After attending this program I feel motivated to make my mental health a priority	Strongly DisagreeAfter attending this program I feel motivated to make my mental health a priority Strongly Disagree	DisagreeAfter attending this program I feel motivated to make my mental health a priority Disagree	NeutralAfter attending this program I feel motivated to make my mental health a priority Neutral	AgreeAfter attending this program I feel motivated to make my mental health a priority Agree	Strongly AgreeAfter attending this program I feel motivated to make my mental health a priority Strongly Agree
I felt safe during this program	Strongly DisagreeI felt safe during this program Strongly Disagree	DisagreeI felt safe during this program Disagree	NeutralI felt safe during this program Neutral	AgreeI felt safe during this program Agree	Strongly AgreeI felt safe during this program Strongly Agree
I learned something new during the program	Strongly DisagreeI learned something new during the program Strongly Disagree	DisagreeI learned something new during the program Disagree	NeutralI learned something new during the program Neutral	AgreeI learned something new during the program Agree	Strongly AgreeI learned something new during the program Strongly Agree
I felt supported during this program	Strongly DisagreeI felt supported during this program Strongly Disagree	DisagreeI felt supported during this program Disagree	NeutralI felt supported during this program Neutral	AgreeI felt supported during this program Agree	Strongly AgreeI felt supported during this program Strongly Agree
Given today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life	Strongly DisagreeGiven today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life Strongly Disagree	DisagreeGiven today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life Disagree	NeutralGiven today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life Neutral	AgreeGiven today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life Agree	Strongly AgreeGiven today's experience with the Integrated Wellness Services I can see myself incorporating wellness practices into my daily life Strongly Agree

How did you feel before the program started today

How do you feel now?

How would you feel about participating in another program like this one?

How would you feel about recommending this program to others?

Comments

Would you like to share your experience publicly as a testimonial of how BLHF free mental wellness support helped you?

Yes
No

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