MASG Feedback Form February 2023

When you applied for the Memory Activity and Support Groups Grant, you agreed to complete this Feedback Report and return it to us, together with evidence of the spend e.g. copy receipts, invoices, etc, within the time frame specified on your application form. In order to understand how the grant has helped your Group, we would like to ask you a few questions. We are passionate about assisting people with memory impairment so all feedback is valuable and may be used to secure further funding for this particular need.

Failure to submit a feedback report with all receipts may result in us asking for all or part of the grant monies to be returned and we will not be able to consider your group for any future funding until this is received.

If you need any help completing this form, please call us on 01736 756655.

Application Number* This field is required.

Name of the group* This field is required.

Did you use the money for anything that wasn't specified in your application form? If yes, please tell us what you did differently.* This field is required.

Please give us a breakdown of what your grant was spent on below, also indicating if receipts enclosed (if not please explain why in the next question)* This field is required.

Please upload your evidence of costs here* This field is required.

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If you did not have any receipts enclosed for activities/items, please explain why here.* This field is required.

Please tell us how the grant has helped your members health and wellbeing and what difference this has made to them, e.g. their quality of life has improved, they are more supported, less isolated, etc* This field is required.Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information (Please include anonymous feedback/quotes from group members where available)

Has this grant or item improved members' quality of life?* This field is required.

Not at all

Not much

Neutral

A little

Very much so

Other

Has this grant activity or item reduced the need for additional support?* This field is required.

Not at all

Not much

Neutral

A little

Very much so

Other

If you feel that this grant programme could be improved, please tell us how?* This field is required.

We would love to hear more about the impact your Group has had on members health and wellbeing and how this grant has helped them. If you would be kind enough to tell us more, we can use this information (anonymously) to show Cornwall Council and NHS Cornwall & The Isles of Scilly ICB how vital this grant is in supporting carers.

(Please note, you do not have to complete this section)

Could you give us a case study telling us a little bit about the impact that having memory impairment has had on your members general health & wellbeing. * This field is required.Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information.

How does being part of this group support them with their health and wellbeing? What difference has it made to them? * This field is required.Examples can be anecdotal

Signature* This field is required.

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