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BK 00026 PG <br />Matter of Balance (MOB) <br />Class started on <br />Number of sessions <br />and ended on <br />Number of total participants <br />Number of participants who completed at least 6 of 8 classes <br />Leader Names 1. <br />2. <br />Place /Location <br />Required documentation: Attendance, Release Form, First Session Survey, Last Session Survey, Class <br />Evaluation <br />CHECK ONE: <br />Living Healthy: Chronic Disease Self Management Program (CDSMP) <br />Diabetes Self Management Program (DSMP) <br />Class started on <br />Number of sessions <br />and ended on <br />Number of total participants <br />Number of participants who completed at least 5 of 6 classes <br />Leader Names 1. <br />2. <br />Place /Location <br />Required documentation: Workshop Information Cover Sheet, Attendance Log, Participant Information Survey, <br />Workshop Evaluation Form <br />Other Evidence Based Program (e.g. Arthritis Foundation Tai Chi Program Walk with Ease Fit and <br />Strong. Healthy IDEAS or PEARLS. EnhanceWellness EnhanceFitness Active Choices Strong for Life <br />etc.. If you have questions, please contact Ashley Price at 919 -558 -2711 or aprice(Mocoa ora)• <br />TJAAA Addendum Form July 2014 - June 2015 <br />