Artists in the Schools Evaluation Email Form

Arts in Medicine / Arts for Elders
Evaluation Email Form

Program Date(s):
Program/Performer:
Your Name:
Your Position:
Facility:
Email Address:
We hope you, your staff and the residents/patients who attend your facility enjoyed this live performance/ in-service workshop. Thank you for completing the following survey. Your input helps us in securing future funds so that we may continue to provide arts experiences for facilities such as yours. Rating scale: 1 = Poor, 4 = Satisfactory, 7 = Excellent
1.	Approximately how many people experienced this program?
	Who attended the Program? Where there any staff members, visiting guests, others?
2.	How many total performances took place?
	Where did the performance(s) take place?
Rating scale: 1 = Poor, 4 = Satisfactory, 7 = Excellent
3.	How would you rate the artistic level of this program?
	1	2	3	4	5	6	7
	Poor		Satisfactory			Excellent
4.	How would you rate the audience reaction to this arts program?
	1	2	3	4	5	6	7
	Poor		Satisfactory			Excellent
5.	How would you rate the effect of the program on the overall emotional/physical health of the individuals who saw the performance?
	1	2	3	4	5	6	7
	Poor		Satisfactory			Excellent
6.	We would appreciate your comments on the strengths and weaknesses of the program:


	Thank you!