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Event, Contest and Initiative Feedback

last modified 2008-09-04

Please fill out this form to give us your feedback about any events, contests or initiatives you have participated in.

Please enter the name of the event, initiative or contest.

Date of event, initiative or contest.

/ /

Please select your CCI Location.

How did you find out about the event, contest or initiative?

Newsletter received at home
Poster at worksite
Information at wellness board/kiosk
Email bulletin
Word of Mouth
Other

If other, please describe.

Overall, the initiative was useful to me.

Please respond to the statement using a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree.

1
2
3
4
5

If you answered with "strongly disagree" please tell us why.

I am more knowledgeable about health and wellness because of the event, initiative or contest.

Please respond to the statement using a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree.

1
2
3
4
5

If you answered with "strongly disagree" please tell us why.

Please provide us with your suggestions/comments.