Forms Needed for Interventions

Please find below a comprehensive list of paperwork needed for each of Missouri’s interventions.  All of these forms can be found on the Leader Resources page in the left column titled “Leader Forms” under “Course” or “Trainings”.

Leader Forms – Courses

CDSMP (Chronic Disease Self-Management Program):

Participant Attendance Sheet (Course Rosters) (1 per workshop)

CDSMP Participant Release (1 form per participant)

Course Participation Questions (Yellow Reach Card) (1 form per participant)

Tomando Control de su Salud:

Participant Attendance Sheet (Course Rosters) (1 per workshop)

CDSMP Participant Release (1 form per participant)

Course Participation Questions (Yellow Reach Card) (1 form per participant)

Arthritis Toolkit:

Arthritis Toolkit Dissemination Plan

Arthritis Toolkit Tracking Form

Arthritis Toolkit Participant Guide (1 per toolkit)

Arthritis Toolkit Participant Contact Card (1 per toolkit)

Arthritis Toolkit Return Materials Checklist (1 per toolkit)

Arthritis Toolkit Evaluation Form (1 per toolkit)

Course Participation Questions (Yellow Reach Card) (1 per toolkit)

Walk With Ease Individual:

AF WWE Individual Tracking Form

AF WWE Individual Participant Evaluation Form (1 form per participant)

Course Participation Questions (Yellow Reach Card) (1 form per participant)

Walk With Ease Group:

Participant Attendance Sheet (Course Rosters) (1 per workshop)

AF Program Information Form (Spanish or English) (Fill-in Format: English) (1 per workshop)

AF Program Co-Sponsorship Form (PDF or DOC) (1 form per hosting organization every 3 years)

AF Participant Release Form (Spanish or English) (1 form per participant)

AF WWE Group Participant Evaluation Form (1 form per participant)

Course Participation Questions (Yellow Reach Card) (1 form per participant)

Arthritis Foundation Exercise Program:

Participant Attendance Sheet (Course Rosters) (1 per workshop)

AF Program Information Form (Spanish or English) (Fill-in Format: English) (1 per workshop)

AF Program Co-Sponsorship Form (PDF or DOC) (1 form per hosting organization every 3 years)

AF Participant Release Form (Spanish or English) (1 form per participant)

Course Participation Questions (Yellow Reach Card) (1 form per participant)

 

Leader Forms – Trainings

Leader Trainings (All Interventions):

Leader Training Roster (1 per training)

        AF Leader Trainings (additional requirements for WWE         Group and Arthritis Foundation Exercise Program):

        AF Training Workshop Roster Form (1 per training)

        AF Program Co-Sponsorship Form (PDF or DOC) (1 form per hosting         organization every 3 years)

        AF Leader Certification Form (PDF or DOC) (1 form per leader)

        AF Leader/Instructor Statement of Understanding (1             form per leader)

  AF Leader/Instructor Training Workshop Application Form (PDF or DOC) (1 form per leader wanting to be trained)

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