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* required information
First Name:
*
Last Name:
*
Email:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
-- please make a selection --
Alabama
Alaska
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District of Columbia
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Not in USA
ZIP/Postal Code:
*
Phone:
Additional Information
mixed facility/please specify:
other/please specify:
Which kit are you evaluating:
Oneg Shabbat
Passover
What kind of setting is your facility:
nursing home
assisted living
retirement community
adult day care
community center
mixed facility
What percentage of the population you serve is Jewish:
80-100%
60-80%
40-60%
20-40%
less than 20%
With which population was Sacred Seasons used in your facility? (Check all that apply.):
high-functioning, independent elders
moderately functioning elders
impaired elders
Who was the program leader for the Sacred Seasons program:
recreation therapist
volunteer
resident’s family member
other staff
other
Was the program leader Jewish:
Yes
No
If not, was the program leader familiar with the celebration of this holiday:
Yes
No
How did you select or recruit a program leader:
Were the directions for the set-up of the program clear and easy to implement:
very clear
clear
somewhat unclear
unclear
Did the program leader’s annotated guide enable the leader to implement the program independently?
He or she was:
very independent
independent
needed some supervision
needed intensive supervision
Was the material easy to download from the Web site:
Yes
No
Any problems? Please specify:
How many times has the program been offered at the facility:
Would you be interested in more Sacred Seasons materials:
Yes
No
If yes, what topics would interest you:
Would you recommend Sacred Seasons to colleagues:
Yes
No
Would leadership training on Sacred Seasons be helpful:
Yes
No
What other needs for Jewish connection and spiritual expression do you see in your population:
How familiar were you with this holiday prior to using Sacred Seasons:
very familiar
familiar
somewhat familiar
not familiar
How easy were the materials to use:
very easy
easy
moderately difficult
difficult
What might make the materials easier to use or more accessible:
How did the participants respond to the program:
What kinds of participation did you notice:
singing along
leading parts of the celebration
tapping fingers or toes, or clapping
demonstrating recognition or familiarity
Did you notice changes in participants’ affect, behavior, or engagement with each other and the environment:
Did any non-Jewish elders join in your celebration:
Yes
No
Comments on participation by non-Jews:
Other comments or suggestions:
1299 Church Road
Wyncote, PA 19095
email:
sacredseasons@rrc.edu
phone: 215.576.0800
fax: 215.576.6143
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