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 - 102Kb

Download

English (Fillable PDFs)

CDSME_Fillable_Forms

.zip - 659Kb

Download

Arabic (Word documents)

CDSME%20Arabic%207

.21 - 1Kb

Download

Cantonese (Word documents)

CDSME-Forms-Cantonese

.zip - 106Kb

Download

Guajarati  (Word documents)

CDSME%20Gujarati%207

.21 - 1Kb

Download

Hindi (Word documents)

CDSME%20Hindi%207

.21 - 1Kb

Download

Hmong (Word documents)

CDSME-Forms-Hmong

.zip - 98Kb

Download

Korean (Word documents)

CDSME-Forms-Korean

.zip - 120Kb

Download

Lao (Word documents)

CDSME-Forms-Lao

.zip - 113Kb

Download

Mandarin (Word documents)

CDSME-Forms-Mandarin

.zip - 94Kb

Download

Portuguese (Word documents)

CDSME-Forms-Portuguese

.zip - 88Kb

Download

Somali (Word documents)

CDSME-Forms-Somali

.zip - 105Kb

Download

Spanish (Word Documents)

CDSME-Forms-Spanish

.zip - 104Kb

Download

Spanish (Fillable PDFs)

CDSME_Forms_Spanish_Fillable_PDFs

.zip - 271Kb

Download

Tongan (Word documents)

CDSME-Forms-Tongan

.zip - 59Kb

Download

Urdu (Word documents) 

CDSME%20Urdu%207

.21 - 1Kb

Download

Vietnamese (Word documents)

CDSME-Forms-Vietnamese

.zip - 97Kb

Download