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* 1. Name of School, program, or organization

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* 2. Please select the county that best describes the location of your school, program or organization

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* 3. Number of participants

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* 4. Grade level of participants

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* 5. The film educated students on what vaping/e-cigarettes are.

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* 6. The film helped students understand the harmful health risks of e-cigarettes.

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* 7. The film effectively used peer-to-peer education to demonstrate the harmful effects of e-cigarettes.

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* 8. The film and discussion guide were helpful tools for me to use with students/athletes.

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* 9. How likely are you to share the Don’t Blow It toolkit?

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* 10. After seeing the information in the toolkit, is there anything you would like to see added?

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* 11. What was one take away you had after watching the film? 

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