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Music & Wellness Evaluation Form
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Name
*
First
Last
Email
*
Date of Presentation
*
Name of Presenter
*
First
Last
Number of Attendees
*
The presenter chose appropriate music for the audience and was engaged with his/her audience members
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Strongly Disagree
Disagree
Agree
Strongly Agree
If able, residents exhibited improvement in communication skills as a result of the performance
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Strongly Disagree
Disagree
Agree
Strongly Agree
If able, residents exhibited improvement in motor function as a result of the performance
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Strongly Disagree
Disagree
Agree
Strongly Agree
If able, residents exhibited improvement in self-expression and social skills as a result of the performance
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Strongly Disagree
Disagree
Agree
Strongly Agree
Overall, the presentation has a positive effect on the residents
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Strongly Disagree
Disagree
Agree
Strongly Agree
We rely on specific stories of how our sessions affect its recipients in a real ways in order to gain grant funding for future presentations. If you know of any particular "stories" you could tell about a student (or client) and how our musicians reached them, it would be very helpful if you shared in the space provided. To protect the client, you can use a fictitious name.
skills Date in
Please list any characteristics of the clients in your audience (e.g. Alzheimer's, Veterans, Dementia, Stroke/Heart victim, MHMR, Emotional Health issues etc...). Please do not use names.
What suggestions would you offer to improve the San Angelo Symphony Music and Wellness program?
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