EmailMe Form - Music And Wellness Evaluation

Name of Facility *

Date of Performance

Name of Activities Director *

Number of Attendees *

Name of MAW Presenter *

First Last

Did you take photos or videos?

yes

no

If so, please email to assistant@sanangelosymphony.org

MAW Music Selections *

Please evaluate the following statements. *

	Strongly Disagree	Disagree	Agree	Strongly Agree
The presenter chose appropriate music for the audience and was engaged with his/her audience members
If able, residents exhibited improvement in communication skills as a result of the MAW performance (expressive and receptive)
If able, residents exhibited improvement in motor function and coordination as a result of the MAW performance (both fine and gross motor skills)
If able, residents expressed an improvement in self-expression and social skills with others around them as a result of the MAW performance
The MAW presentation had a positive effect on the residents

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.

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? *

Please rate the overall MAW presentation *