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Eastlake Group Exit Form
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* Indicates required question
Which group did you participate in?
*
Empowerment
Me & My choices about peer pressure
Managing Me
Family Concerns
Who did you have group with?
*
Cook
Alesnik
Golnick
List 3 skills/strategies that you learned in group
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Your answer
This group was helpful for me
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Strongly Agree
1
2
3
4
5
Strongly Disagree
I learned new information in this group
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Strongly Agree
1
2
3
4
5
Strongly Disagree
I felt connected with others in this group
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Strongly Agree
1
2
3
4
5
Strongly Disagree
I talked honestly about my feelings
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Strongly Agree
1
2
3
4
5
Strongly Disagree
I would recommend being in a group to my friends
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Strongly Agree
1
2
3
4
5
Strongly Disagree
The best thing about this group was
*
Your answer
The thing I liked least about the group was
*
Your answer
What is your goal?
*
Your answer
What steps will you take to achieve your goal?
*
Your answer
Any comments/Suggestions
Your answer
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