COMMUNITY GARDENING PROGRAM

Healthy Lifestyle Education

Initial Evaluation
ID Number: ___________ Date: ____________

Cooperative Extension is always looking for ways to serve you better. Please take a moment to
complete this short survey. It will help us know how we’re doing, and how we can better serve
your needs in the future. Your Identification number is used to match your pre evaluation with
post evaluation for comparison.

For each of the following practices, please circle the number that best describes
your current behavior.
I am not I am I am I am I am
Practices consider consider doing doing this doing
ing this ing this this most of this all
sometim the time of the
es time
1. Eat the recommended
servings from the five food 1 2 3 4 5
groups daily.
2. Eat 2 1/2 cups or more of
1 2 3 4 5
vegetables per day.
3. Eat at least 2 cups of fruit per
1 2 3 4 5
day.
4. Eating dried beans or peas. 1 2 3 4 5
5 Eating at least 2 servings of
low-fat or non-fat dairy 1 2 3 4 5
products each day.
6. Eat fruit for dessert and
snacks more often than
cookies, cakes, pies, ice cream 1 2 3 4 5
or other high fat, high sugar
foods.
7. Consume whole grain breads
1 2 3 4 5
and cereals.
8. Eating baked, broiled, or
grilled foods rather than eating 1 2 3 4 5
fried foods.
9. Do some type of moderately
intense physical activity such
as walking for at least 30 1 2 3 4 5
minutes five or more days a
week.
10. Reading nutrition labels to
1 2 3 4 5
make healthy food choices.

How did you learn about this training workshop?

_________________________________________________

What do you expect to gain by participating in this program?

Demographics
What is your gender?
____ Male
____ Female

How do you identify yourself?

___African American ___White
___American Indian/Alaskan ___Native Hawaiian/Pacific
Islander
___Asian ___Other
___Hispanic/Latino

Thank you for completing this evaluation.

We appreciate your input as we make every effort to improve our Extension
programs.
 COMMUNITY GARDENING PROGRAM
Healthy Lifestyle Education
Mid-Term Evaluation
ID Number: ___________ Date: ____________

Cooperative Extension is always looking for ways to serve you better. Please take a moment to
complete this short survey. It will help us know how we’re doing, and how we can better serve
your needs in the future. Your Identification number is used to match your pre evaluation with
post evaluation for comparison.

Satisfaction
Please circle the appropriate number for your level of response.
How satisfied are you with: Not Somewhat Satisfi Very
Satisfied Satisfied ed Satisfied
The relevance of information to your 1 2 3 4
needs?
Presentation quality of instructor(s)? 1 2 3 4
Subject matter knowledge of 1 2 3 4
instructor(s)?
Training facilities? 1 2 3 4
The overall quality of the training 1 2 3 4
workshop?

Was the information easy to understand? ___Yes ____No

For each of the following practices, please circle the number that best describes
your current behavior.
I am not I am I am I am I am
Practices consider consider doing doing this doing
ing this ing this this most of this all
sometim the time of the
es time
1. Eat the recommended
servings from the five food 1 2 3 4 5
groups daily.
2. Eat 2 1/2 cups or more of
1 2 3 4 5
vegetables per day.
3. Eat at least 2 cups of fruit per
1 2 3 4 5
day.
4. Eating dried beans or peas. 1 2 3 4 5
5 Eating at least 2 servings of
low-fat or non-fat dairy 1 2 3 4 5
products each day.
6. Eat fruit for dessert and
snacks more often than
cookies, cakes, pies, ice cream 1 2 3 4 5
or other high fat, high sugar
foods.
7. Consume whole grain breads
1 2 3 4 5
and cereals.
 8. Eating baked, broiled, or
grilled foods rather than eating 1 2 3 4 5
fried foods.
9. Do some type of moderately
intense physical activity such
as walking for at least 30 1 2 3 4 5
minutes five or more days a
week.
10. Reading nutrition labels to
1 2 3 4 5
make healthy food choices.

How can the remainder of this program best meet your learning needs?

Thank you for completing this evaluation.

We appreciate your input as we make every effort to improve our Extension
programs.
 COMMUNITY GARDENING PROGRAM
Healthy Lifestyle Education

End-of-Program Evaluation

ID Number: ___________ Date: ____________

Cooperative Extension is always looking for ways to serve you better. Please take a moment to
complete this short survey. It will help us know how we’re doing, and how we can better serve
your needs in the future. Your Identification number is used to match your pre evaluation with
post evaluation for comparison.

Satisfaction
Please circle the appropriate number for your level of response.
How satisfied are you with: Not Somewhat Satisfi Very
Satisfied Satisfied ed Satisfied
The relevance of information to your 1 2 3 4
needs?
Presentation quality of instructor(s)? 1 2 3 4
Subject matter knowledge of 1 2 3 4
instructor(s)?
Training facilities? 1 2 3 4
The overall quality of the training 1 2 3 4
workshop?

Was the information easy to understand? ___Yes ____No

For each of the following practices, please circle the number that best describes
your current behavior.
I am not I am I am I am I am
Practices consider consider doing doing this doing
ing this ing this this most of this all
sometim the time of the
es time
1. Eat the recommended
servings from the five food 1 2 3 4 5
groups daily.
2. Eat 2 1/2 cups or more of
1 2 3 4 5
vegetables per day.
3. Eat at least 2 cups of fruit per
1 2 3 4 5
day.
4. Eating dried beans or peas. 1 2 3 4 5
5 Eating at least 2 servings of
low-fat or non-fat dairy 1 2 3 4 5
products each day.
6. Eat fruit for dessert and
snacks more often than
cookies, cakes, pies, ice cream 1 2 3 4 5
or other high fat, high sugar
foods.
7. Consume whole grain breads
1 2 3 4 5
and cereals.
8. Eating baked, broiled, or
grilled foods rather than eating 1 2 3 4 5
fried foods.
9. Do some type of moderately
intense physical activity such
as walking for at least 30 1 2 3 4 5
minutes five or more days a
week.
10. Reading nutrition labels to
1 2 3 4 5
make healthy food choices.

What is the most important change you made as a result of participating in this Extension
program?

Did that change help you save or earn money? ____Yes ____No
____Don’t Know

What did you like the most about this program?

What did you like the least about this program?

Have you shared what you learned with others? ____Yes ____No

If yes, how many people did you share this information with?_____

Did the training program meet your expectation? ___Yes ____No

Would you recommend this training program to others? ___Yes ____No

If not,
why:__________________________________________________________________________________________
______

How could this program be further improved?

Share your name/address/phone number, if you are willing to allow us to contact you for
follow-up comments (Optional).

Name: ________________________________ Phone Number: ______________________________

Address: ___________________________________________________________________________

Thank you for completing this evaluation.

We appreciate your input as we make every effort to improve our Extension
programs.
 COMMUNITY GARDENING PROGRAM
Healthy Lifestyle Education

Progress Evaluation

ID Number: ___________ Date: ____________

Cooperative Extension is always looking for ways to serve you better. Please take a moment to
complete this short survey. It will help us know how we’re doing, and how we can better serve
your needs in the future. Your Identification number is used to match your pre evaluation with
post evaluation for comparison.

Indicators: At the In the Middle At the End of

Beginning of of the the Program
the Program Program
Body weight
Blood pressure
Blood glucose
Total cholesterol
Number of vegetable servings
per day
Number of fruit servings per
day
Number of hours physically
active per week
Monthly food expenditure
Average number of meals
taken from fast food
restaurants per week