Creative Impact Feedback Form
Your voice helps us make this program better! You don’t need to be an artist — just honest.
About Today’s Session
Name
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First Name
Last Name
Date of today’s session
*
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Month
-
Day
Year
Date
Facilitator
*
Session #
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Quick Check-In
How would you rate today’s Creative Impact session?
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4 - Excellent
3 - Good
2 - Okay
1 - Not Helpful
Did you feel comfortable and supported during the activity?
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4 - Yes, very much
3 - Mostly
2 - Not really
1 - Not at all
The activity helped me:
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Relax and de-stress
Express myself
Learn something new
Connect with others
Think about recovery/reentry in a new way
Open Reflections
What part of today’s session was most meaningful for you?
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Was there anything you didn’t like or that felt uncomfortable?
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What ideas do you have for future Creative Impact activities?
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Final Check-Out
Share Your Art (Optional)
Would you like to share today’s art?
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Yes
No
After today’s session, I feel:
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Calmer
Inspired
Neutral
Stressed
I give permission for Life Changes to use images of my artwork for program reports, grant documentation, educational materials, and social media. I understand that my name will not be shared without additional written consent.
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Yes
No
Artwork images are used to highlight participant growth and program impact. Identifying information will not be shared without written consent.
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Artwork cleared for reporting/social media use: Yes/No
*
Upload a photo of today’s artwork
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of
Session Satisfaction Score
Comfort & Support Score
Activity Impact Count
Emotional Check-Out Score
Overall RSAT Feedback Score
Internal Only – RSAT Feedback Summary
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