Program Data/Forms

The Oregon Department of Human Services asks your assistance in collecting information about where Living Well/ CDSMP programs are being offered across Oregon and who’s participating. This information helps track statewide successes and identify additional training, funding, or other support needs. We regularly report this information on a statewide basis; please click the link below for the latest update.

To receive a report of Living Well program information specific to your community or region, please contact the DHS Living Well team at: 971-673-0984 or living.well@state.or.us.

Data on Living Well/Self-Management Programs & Participants in Oregon

Data since 2005 (pdf)

To report program and participant information from programs, please use the forms below:

• Upcoming Program Information can now be submitted online! Please send us information about all upcoming programs, whether or not they're open to the public.

   

• Participant Information (pdf)

   

  Please have each program participant complete this form at the end of the first session they attend. Please mail or fax completed forms to DHS (along with the Program Summary form) within 2 weeks of completing the program. DHS does not collect participant names.
   Participant Information (Spanish) (pdf) 

   

• Program Summary information can also be reported online! Please complete this at the end of each 6-week program you lead and submit info to DHS within 2 weeks of completing the program. Program Summary (Spanish) (pdf)