Survey Order Form - Prison Yoga Project Community

Read Before Ordering

Please submit one form per program or class.

For example, if you need surveys for three different classes or programs, you must complete this form three separate times—one submission for each class.

Why?

To ensure you receive the correct number of surveys for each individual class, without needing to count them out manually from a large combined stack.
To help us accurately track which programs have been surveyed and which still need surveys.

Facilitator Name(Required)

First Last

Email(Required)

Program You’re Ordering Surveys For

Facility Name(Required)

Example: Richard J Donovan Correctional Facility

Program Name / Yard / Day / Designation(Required)

Example: RJD_Saturday_10:30

Select the population of your program(Required)

Adult

Youth

Is your program a California Department of Corrections & Rehabilitation (CDCR) program?(Required)

Yes

Select which option best describes your program(Required)

Runs in cohorts with clear start and end dates (we will send pre & post surveys)

Open-enrollment model where participants join and leave on a rolling basis (we will send only post-surveys)

Quantity Needed(Required)

(Number of participants in your class)

How would you like to receive and return the surveys?(Required)

(US ONLY) PYP mails the surveys to me. I mail the surveys back to PYP using a pre-paid return label.

(US & INTERNATIONAL) I print the surveys myself. I scan the surveys and upload them to PYP’s Submission Form.

Email to Receive Surveys(Required)

Shipping Address for Surveys

This may be the facilitator’s address, or facility’s shipping address (depending on clearance and facility’s requirements)

First Name(Required)

Last Name(Required)

Company(Required)

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country