Aseshate:ka'te Grief Recovery Group Evaluation

Name

First Name Last Name

Email

example@example.com

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

What year did you attend?

2019 2018 2017 2016 2015 2014

Would you be interested in attending monthly maintenance groups to continue working on your grief issues?

Yes No Undecided at this time

How satisfied were you with the program in addressing your grief issues? 1 being not so much, 5 being very satisfied in addressing my grief issues.

Were you satisfied with the outcome of your grief work in group? Explain.

Do you have any suggestions on how the group could improve?

What did you like about the group?

What didn't you like about the group?

Do you have any suggestions for the facilitator to improve upon delivery of the material?

Would you recommend this group to someone else?

Yes No

Would you be willing to write a testimonial expressing the value of attending the grief recovery group had in addressing your grief issues? If so, please share below. *Your testimonial may be printed on brochures or on the website as encouragement for others who may need help working through their grief. Because this group is confidential, your name at the end of the testimonial is optional. Feel free to use "anonymous" or just your initials to maintain your anonymity if you choose. Niawen!