Take Charge Programs Leader Resources

Includes workshop material for:

  • Take Charge of Your Health (CDSMP)
  • Take Charge of Your Diabetes (DSMP)
  • Take Charge of Your Pain
  • Cancer: Thriving and Surviving

Upon workshop completion, email attendance sheet to joan.fox@ageoptions.org

If you will NOT be entering class participant data, and participants are NOT using electronic forms, email the completed participant forms to joan.fox@ageotions.org


Course Materials for Leaders

Data Collection ChecklistFor all Take Charge Programs. Instructions for data collection from registration to last session

Attendance SheetExcel Document

Attendance Sheet- Printable Form

Session 1 Data Collection Script- To be read aloud to participants during Session 1

Session 1 Virtual Data Collection Script- To be read aloud to participants during Session 1

Photo Media Release- This form is optional; to be used if collecting testimonials or taking pictures. Feel free to edit to add your organization's information

 


Forms for Participants

Participants can choose one of the following options when completing paperwork:

  • Complete a paper form or fillable PDF
  • Receive a link to complete an electronic form (through Microsoft Forms)
  • Register for a participant portal on the IL Pathways website and complete forms directly in the portal

Note: If you choose to you use Microsoft Forms, the surveys are submitted directly to AgeOptions. AgeOptions will complete the data entry. 

Session 1 Participant Registration Forms and Pre-Survey

Option 1:

*CCDPH Partners- Use the following surveys: English - Arabic - Gujarati - Hindi - Urdu 

Option 2:

  • Link to Electronic Participant Registration Packet and Pre-Survey- Email us at info@ilpathwaystohealth.org to request a survey link for you specific workshop. 

Option 3:

Session 1 Handouts for Participants 

(One form per participant)

Welcome Letter- CDSMP - DSMP - PAIN - CANCER   Coming Soon!

Workshop Overview and Homework by Session- CDSMP - DSMP - PAIN - CANCER 

Menu Planning 1- For Take Charge of Your Diabetes only

Menu Planning 2- For Take Charge of Your Diabetes only

Last Session Forms

Option 1:

*CCDPH Partners- Use the following surveys:  English - Arabic - Gujarati - Hindi - Urdu

Option 2:

  • Link to Electronic Participant Post Survey- Email us at info@ilpathwaystohealth.org to request a survey link for you specific workshop. 

Option 3:

  • Participant Guide for ILPTH Portal- Instructions that can be sent to participants for completing electronic forms on the ILPTH participant portal (These are the same instructions that are available above for completing Session 1 forms)

 


Links and Other Materials

Individual forms included in Participant Registration Packet- Registration Form, Privacy Policy, and Liability Waiver

Workshop 101

Pre-workshop Checklist and Participant Recruitment Plan

Email Templates- For leaders to send to participants for online workshops

Zoom Instructions- (Provided by Rush) For online workshops

Participant Certificate of Completion Template

Crisis Intervention Plan- Provides general guidance about what to do in crisis situations

Fidelity Visit Checklist

Receipt Template for Books/CD's

Brief Body Scan- Contact us if you would like to purchase a CD. You may also Google or use YouTube to find a meditation.

 


Marketing Materials

IL Pathways to Health Logo

ILPTH Evidence Based Program Flyer

ILPTH Outreach Toolkit Template- This Toolkit includes templates for flyers, posters, social media posts, etc. You will need to have a Canva account to access the template and create a COPY to make edits (DO NOT EDIT THE TEMPLATE). If you need help doing so, please refer to our Canva User Guide.