AU/CTF Evaluation Project
Retrospective Pre-Post Survey
Instructions to Provide to Participants
It is important that participants understand how to complete the retrospective survey when you give it to them at the
end of your program. If they do not pay attention to the instructions, they may not complete it correctly. The following
information should be used to explain the instructions to participants when you give them the survey.
This survey asks about things related to the program you have just finished. For each question, provide two
responses. The left side of the page is where you will place a checkmark to tell us about these things before you
participated in this program. The right side of the page is different. Place a checkmark on that side to let us know
about these things now that you have participated in the program.
Quarter Submitted: 1st ___ 2nd ___ 3rd ___ 4th ___
*Give this survey to people at their last session only.*
Respite Care Programs
Participant ID #
rogram Contract ____
• How many hours did you participate in this program? _______hours.
• How many sessions did you participate in? _______sessions.
Complete this survey only if this is your last session. Please provide two responses for each statement below. On the left, place a checkmark in the box to describe
where you were before participating in this program. On the right, place a checkmark in the box to describe where you are after participating in this program.
Before participating in this program…
After participating in this program…
1. My knowledge of community resources wh