Key Takeaways

  • Organizations funded by the Administration for Community Living are required to collect data on evidence-based chronic disease self-management education workshops. 

  • The forms have been translated into the most common languages used for workshop implementation. Contact us if you don't see the language you need.

Download the forms by language below. Each file is a zip folder with the following forms: 

  • Host/Implementation Organization Information Form
  • Program Information Cover Sheet 
  • Attendance Log 
  • Participant Information Survey 
  • Group Leader Script

English (Word documents)

CDSME-Forms-English

.zip

Download

English (Fillable PDFs)

CDSME_Fillable_Forms

.zip

Download

Cantonese

CDSME-Forms-Cantonese

.zip

Download

Hmong

CDSME-Forms-Hmong

.zip

Download

Korean

CDSME-Forms-Korean

.zip

Download

Lao

CDSME-Forms-Lao

.zip

Download

Mandarin

CDSME-Forms-Mandarin

.zip

Download

Portuguese

CDSME-Forms-Portuguese

.zip

Download

Somali

CDSME-Forms-Somali

.zip

Download

Spanish (Word Documents)

CDSME-Forms-Spanish

.zip

Download

Spanish (Fillable PDFs)

CDSME_Forms_Spanish_Fillable_PDFs

.zip

Download

Tongan

CDSME-Forms-Tongan

.zip

Download

Vietnamese

CDSME-Forms-Vietnamese

.zip

Download