Audiences Unlimited Evaluation Form
Audiences Unlimited, Inc. evaluation for In-Facility and/or Room-to-Room (or bedside) performances
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Email *
Date of Performance *
MM
/
DD
/
YYYY
Time of Performance
Time
:
Artist Name *
Audience Member/Facility Type *
For special audience types within the facility - see questions below
Required
Facility or Organization Name *
Choose your facility name from the drop down list
Check if Room-to-Room
Select this if entire program is Room-to-Room
Total Daily Census *
Total Number Attendees *
Number of Females *
Number of Males *
If this was a special or themed event, please check what type
For each applicable statement listed below, please select the number that best reflects your judgement of how much impact the performance had on the audience members who are able to accomplish the activity being evaluated:
Audience member actively responded by smiling, laughing or nodding. *
Audience member independently engaged in program by making requests, singing and/or taking part in a sing-along or dancing. *
Audience member responded when prompted by performer(s) or program coordinator or staff. *
Additional comments about the audience members' response to the program or a special story about reactions or interactions.
(Optional) Anything unique about the artist's performance or interaction with the audience today?
This is not for commenting on the artist's quality. Please use the Artist Evaluation Form or Artist Restriction Form for those type of comments.
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