Name: Student NameE-Mail: Student@email.comCourse ID#: ME1-StartDate

Assessment Audit Tool

Review 10% of your current population. Using this form add the number of residents interested in the programs. You should be specific as to individual interests, including names of favorite teams, TV Shows, type of music or radio programs.

Total Number of Residents in your facility: _____ 10% would be: _____

Hobbies__Gardening__ Pets__ Family Events__ Holiday Celebrations__ Bird Watching__ Boating__ Camping__ Hunting__ Fishing__ Cooking__ Baking__ Computer__ Reading__ Traveling__ Newspaper__ _____________________ ___________________

Favorite Games__ Crosswords__ Bingo__ Word Search__ Jigsaw Puzzles__ Casino Games__ Board Games__ Computer Games__ Group Games__ Trivia__ _____________________ ___________________

__ Flower Arranging__ Letter Writing__ Nature Interests__ Travel__ Poetry__ Antiques/Collectibles__ Museums__ _____________________ ___________________

Spiritual Needs__ Services (attends regularly)__ Bible Study__ Meditation__ Family Events__ Temple__ Protestant Service__ Catholic Mass__ Clergy Visit (1-1)__ ___________________SportsName of Team________________________ Baseball__ Football __ NASCAR__ Basketball__ Hockey__ Soccer__ Horseshoes__ Bocce Ball__ Horse Racing__ Snow Sports__ Olympics__ ___________________

__ Self Advocacy __ Support Groups__ Shopping__ Intergenerational__ VFW/Legion__ Instrument Played__ Social Membership__ __________________ ________________

__ Antiques/Collectibles__ Museums__ _____________________ ___________________

Card Playing__ Poker__ Bridge__ Hearts/Spades__ Solitaire__ Rummy__ _____________________ ___________________

Crafts__ Knitting__ Cooking__ Crocheting__ Sewing__ Painting__ Ceramics__ Scrapbooking__ Woodworking__ Writing/Journaling__ Home decor__ Rubber Stamping__ Model Making__ Crafty Crafts__ Art Projects__ Quilting__ Holiday Crafts__ Dancing__ ___________________

Other__ Movies__ Documentaries__ Fixing Things__ Talk Radio__ Music__ _____________________ ___________________

__ Restaurants__ Politics__ ___________________