Good-Touch/Bad-Touch Data Collection School Year 2009-10

1. Demographic Information

Childhelp appreciates your assistance in collecting annual program data to measure the number of children reached with our prevention education program Good-Touch/Bad-Touch. Please help us determine the total number of students you have served in the school year 2009-10, and update your contact information.

1. Please fill out your demographic information:

Please fill out your demographic information: Name:
School District/Organization you work for:
School/Agency you work within:
Address:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. What year were you certified as a Facilitator?

What year were you certified as a Facilitator?