Post-Course Report | Eat Breathe Thrive Series

Your Name:*

First NameLast Name
Email:*
example@example.com
Your Course
Did you work with a co-facilitator?*

YesNo
Co-Facilitator's Name:

First NameLast Name
Did you lead your course online or in-person?*

OnlineIn-person
Where did you lead your course?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course Start Date:*

MonthDayYear
Course End Date:*

MonthDayYear
Session Start Time:*

:HourMinutesAM/PM Option
Session End Time:*

:HourMinutesAM/PM Option
Your Service Project
Who did the project serve?*

Youth (up to the age of 18)Populations facing poverty or homelessnessLGBTQ+ communitySpecific racial/ethnic/religious groupIndividuals with mental illness or disabilityIndividuals with physical illness or disabilityRefugees, asylum seekers and/or migrantsVeterans and active duty militarySurvivors of sexual assault and/or gender-based violenceSurvivors of physical abuse or violencePrison-based or incarcerated populationsFirst responders (police, fire, paramedic)Animals at an animal rescue or shelterOther
Number of individuals served:*
Please describe your group's service project:*
Did you partner with or support another nonprofit organization/project for your service project?*

Yes, we partnered with another nonprofit organizationYes, our service project supported another nonprofitNo
Name of nonprofit organization/project:
Nonprofit organization's website URL, if applicable:
If you acquired any donations for your service project, please give details below:
For each donation, include the donation type, quantity, and donor
What was your most memorable moment or experience from the service project?*
Did you take any photos (or screenshots) of the service project?*

YesNo
Please use the button below to upload any photos of the service project, which you have permission to share:

Browse Files

Cancelof
Please use the space below to record testimonials, thoughts, or feedback from participants, relating to their experience of the service project:
Please use the space below to record any other thoughts or comments you wish to share, relating to the service project:
Course Participation
How many participants enrolled in your course?*
Were all participants present for the entirety of all scheduled sessions?

YesNo
Please describe the circumstances that led the participant(s) to miss a scheduled session:
Did any participants drop out of your course?*

YesNo
Please describe why they dropped out, if known:
Did you have to ask any participants to leave the course?*

YesNo
Please describe the circumstances that led to you asking the participant(s) to leave:
Participant Engagement

Participants consistently attended sessions (excluding any extenuating circumstances).*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Participants were actively engaged during discussions and activities.*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Participants seemed interested in the content of the program.*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Participants built friendships and a sense of community among one another.*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Participants were able to express their thoughts, feelings, and experiences.*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Participants reported improvements in their relationship with food, body, and self.*

	1	2	3	4	5

1 is Strongly disagree, 5 is Strongly agree

Other
Did you take any other photos (or screenshots) during the course?*

YesNo
Please use the button below to upload any photos which you have permission to share:

Browse Files

Cancelof
Please use the space below to share any other relevant information about how your course went:
Should be Empty:

Your Course

Your Service Project

Course Participation

Participant Engagement

Other