Painted Brain Reentry Through the Arts Program Survey

PB Reentry Through the Arts Program Survey

Entry Evaluation
Name

First NameLast Name
Pronouns
Date

MonthDayYear
Date
Age

18 - 2526 - 3536 - 4565 - Over
Racial & Ethnic Identification
Please answer the following questions to the best of your knowledge on a scale from 1 - 5.

1 = Not At All / Worst - 5 = All the time / Best
How connected do you feel to your local arts community?

1

2

3

4

5

1 is Worst, 5 is Best
How would you rate your current overall mental health and wellness?

1

2

3

4

5

1 is Worst, 5 is Best
How would you rate your skills and knowledge of art creation?

1

2

3

4

5

1 is Worst, 5 is Best
How would you rate your skills and knowledge of art curation?

1

2

3

4

5

1 is Worst, 5 is Best
How strongly do you believe in community healing through the arts?

1

2

3

4

5

1 is Worst, 5 is Best
How confident do you feel about marketing and showcasing your current artwork?

1

2

3

4

5

1 is Worst, 5 is Best
What are you most curious to learn about from this program?
Please list art materials & or equipment you'd like to use during this program. (ex: acrylic, sketchbook, etc)
Should be Empty:

PB Reentry Through the Arts Program Survey