Bringing Mindfulness to Life @ Work Feedback Form

Bringing Mindfulness to Life @ Work Feedback Form

Please fill in as much information as possible. If you need to save the form and finish it at a later time, there is a 'Save' button at the bottom of the form. You will receive a link to your email address to fill in the rest of the form at your convenience.
Full Name:*

First NameLast Name
Email address (used to send you a unique link if you need to finish the form later):
Employer:*
Occupation and position:*

Overall Course Satisfaction:*

Overall score out of 10:*

	1	2	3	4	5	6	7	8	9	10

1 is Dissatisfied, 10 is More than Satisfied

How would you rate the impact of the course on your:*

	Declined	No Change	Improved	Much Improved
Ability to regulate stress
Management of time and tasks
Workplace relationships
Feelings of confidence and competence
Work-Life Balance
Interpersonal communication

What have been the benefits of doing this course?
What is the number one problem or concern that the course addressed or solved for you?*
What aspect of the course did you find most challenging?
What are you doing differently as a result of doing this course?*
What have you learned that you will continue to practice?
How would you rate Sharn’s facilitation of the course? (highlight all that apply, and give a score out of 10 below)*

PoorGood enoughSkillfulKnowledgeableResponsiveEngagingAuthenticOther

Rating:*

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Fantastic

What suggestions can you make for improving the course:
Organisation:
Content:
Resources:
Facilitation:
Do you feel the course has been a worthwhile investment in staff wellbeing?*

YesNo
Would you recommend the course to colleagues?*

YesNo
Would you like further opportunities and support to continue learning and practicing mindfulness?

YesNo
If ‘YES’ what support or opportunities would you like?
Are you willing to provide testimony about your experience of the course?*

YesNo
Are you happy for comments made on this feedback form to be used as testimony?*

YesNo
Do you want to receive information about future courses and retreats offered by Sharn? (If you answer ‘NO’ Sharn will remove your email address from her list for receiving notices of upcoming Mindful Works events. All notices have an option to Unsubscribe.)*

YesNo
Do you require a ‘Certificate of Participation’? (This will be emailed as downloadable PDF.)*

YesNo
THANK YOU FOR YOUR PARTICIPATION AND FEEDBACK

HERE’S TO BRINGING MINDFULNESS TO LIFE
WHEREVER YOU ARE!
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