Watch Video | Dementia Friends Indiana

1. Contact Info

Name*

Email*

Address*

County*

Where did you hear about DFI?

Organization/University Affiliation

How many people watched the video?*

If you are filling out your own evaluation as an individual viewer, please enter "1" to count yourself only. If you are completing the evaluation on behalf of a group as a whole, please enter the total number in attendance.

I/we have watched the video session in its entirety.

2. Evaluation

1. My awareness has increased about Alzheimer’s and other related dementias.*

Agree
Disagree

Please explain

2. I feel more confident/equipped as a community member to recognize the signs and offer support to the needs of a person living with dementia in the community.*

Agree
Disagree

Please explain

3. I am inspired to offer support and be a friend to people living with dementia in my community.*

Agree
Disagree

Please explain

4. I am likely to adopt dementia friendly practices in my personal or professional life.*

Agree
Disagree

Please explain

3. Actions

Please tell us how you are going to turn your understanding of dementia and what it means to be a Dementia Friend into practical action. Every action counts. As a Dementia Friend, I am committing to:

Choose 3 or more actions:

Getting in touch and staying in touch with someone I know living with dementia
Supporting dementia friendly efforts in my community
Starting a dementia friendly effort in my community
Volunteering for an organization that helps people with dementia
Campaigning for change, e.g. contacting local government, businesses, etc
Encouraging friends to be Dementia Friends (www.dementiafriendsindiana.org)
Carrying out a personal action e.g. being more patient when out in my community
Advancing awareness of Dementia Friends Indiana
Adopting 1 or more dementia friendly practices in my personal or professional life

Become a Friend Online Session

1. Contact Info

2. Evaluation

3. Actions

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