Participant Closing Questionnaire
Your name (COVEY participant):
First Name
Last Name
When did you begin with COVEY?
-
Day
-
Month
Year
Date
What are some of your favourite memories during your time with COVEY?
Thinking about your time with COVEY, from when you were first referred to now, how would you rate the following things (1 star = not at all, 4 stars = a lot):
*
**
***
****
COVEY helped me have fun
COVEY helped me learn new skills
COVEY has given me confidence to try new things
COVEY made me feel better about myself
COVEY made me feel safe and secure
COVEY helped my confidence in meeting new
people
COVEY helped me make friendships
COVEY has given me positive role models
COVEY has given me confidence to express my views and feelings
COVEY has given me confidence to make choices
Has your time at COVEY made a difference to you?
Yes
No
What are the main differences you've noticed about yourself since joining COVEY?
Has your time at COVEY made a difference to your family?
Yes
No
What are the main differences you've noticed about your family since you joined COVEY?
Is there anything you'd like to share that COVEY does well? e.g. relationships, activities, organisation, communication, opportunities
Yes
No
What do you think COVEY could does well?
Is there anything you'd like to share that COVEY could have done better? e.g. communication, activities, organisation, processes
Yes
No
What do you think COVEY could do better?
If someone asked you what it's like to be supported by COVEY, what would you tell them?
Participant's Signature:
The name of the COVEY Team Member completing this form:
First Name
Last Name
COVEY Team Member's Signature:
Name of Parent/Carer/Guardian of participant (if applicable)
First Name
Last Name
Parent/Carer/Guardian of participant's signature (if applicable):
Date completed:
-
Day
-
Month
Year
Date
Continue
Continue
Should be Empty: