Facilitator Report Form

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Your Name
Attendance ( # present / # absent)
1) Name of SM #1 who needs or will need a care receiver
2) Name of SM #2 who needs or will need a care receiver

Evaluate this session: (10 to 1) 10 Good participation 9 8 7 6 5 4 3 2 Poor Participation 1

This was a helpful session: (10 to 1) 10 Very helpful session 9 8 7 6 5 4 3 2 1 Not a helpful session

Members enthusiastic about supervision: (10 to 1) 10 Members are very enthusiastic 9 8 7 6 5 4 3 2 1 Not enthusiastic

I feel good about my leadership: (10 to 1) 10 I feel good about my leadership 9 8 7 6 5 4 3 2 1 I feel discouraged as a leader

Other comments

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