1. General data about the activity
Name of facilitator and community members (If they agree to have their names written here)
Only numbers are allowed. if no participants of a specific category is present, please select 0.
Based on answers from the participants
3. Observations or reflections on Equity, Diversity and Inclusion (EDI)
Data collected here will inform us if the activitities hold an inclusive, diverse, and equitable space.
Please note the discussions related to these three components in this section and how the community was encouraged to embrace a more
EDI perspective and welcome the under-represented groups. The notes will reflect also any spontaneous self-identification with a group
(age, gender, sexual orientation, ethnicity/race, disability, religion, neighborhood, language, etc).
If a question does not apply, please leave it blank.
Name the team members or community members who offered to help, or organizations that were
mentioned in the discussions for each action step
4. Creative Arts Expression
This section refers to any artistic expression present in the activity (art, drama, poetry, creative writing, design, music, dance and movement, baking, gardening, etc.)
Art, drama, poetry, music, baking, gardening, etc.. - Please write approximate numbers of persons using these forms of expression, e.g. art (12), poetry (1), music (1), gardening (1)
please do not write techniques and art materials here
Please write the materials and the approximate number of persons using the same type of material (e.g. yarn (2), acrylic (5), collage (1), watercolour (1), guitar (1)).
5. Discussion Themes
This section will inform us about the discussions between the participants in the activity. We will look into the recurrence of some of the discussions themes in time, to understand what is important for our community. Due to technical constraints, this category seems long. However, the recommendation is to write all the themes down in one paragraph, then to check in what sub-category they fit better. If the discussions do not cover one or more of the bellow sub-categories, please leave them blank.
Describe the highlights of the activity, what worked well and needs to be mentioned, to inspire other communities. The ultimate goal is to collect what our team does well and what happens in our community, to transmit this knowledge further. Due to technical constraints, this category seems long. However, the recommendation is to write all the highlights down in one paragraph, then to check what sub-category matches better. If the highlights do not cover one or more of the bellow sub-categories, please leave them blank. Participants' leadership is a required question since is is very important for our project!
e.g. participants taking lead in explaining a technique to the group - or offering to do a skill share, or an idea about a community activity they want to start, participants being ambassadors for our activities, etc.
Describe the challenges of the activity. What needs to be looked at more carefully, what needs improvement, to transmit this knowledge to other communities. Due to technical constraints, this category seems long. However, the recommendation is to write all the themes down in one paragraph, then to check in what sub-category the fit better. If the discussions do not cover one or more of the bellow sub-categories, please leave them blank. If you have other sub-categories than the below ones, please write all in "Other".
e.g. friendships forming between participants, participant(s) sharing resources of self-care activities with the group, participants opening discussions about their circle of care, etc.
Please do not write names
10. Action steps and further follow up
In these section we collect the interests of our participants and themes of activities they may like to develop or participate in. If you need to have certain materials, or refill them, etc., if the Outreach Coordinators or other members of the team need to be announced,