Monthly Dementia Friends State Reporting

Dementia Friends sub-licensees are required to track the number of Dementia Friends in your state and report these numbers to DFA by the 15th of each month. (For example, report April numbers are due by May 15.) If the the 15th falls on a holiday or weekend, please submit data by the following business day. Contact info@dementiafriendsusa.org with any questions.

Question Title

* 1. Contact Information

Name *

Agency

State/Province *

Email Address *

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* 2. Please provide the month and year for your data.
For example, if you are reporting April numbers due by May 15th, you would respond with April.

Month:

Year:

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* 3. Dementia Friends
Only provide data for Dementia Friends who have NOT become an online Dementia Friend to your knowledge.

Number of new Dementia Friends this month:

Cumulative number of Dementia Friends:

Question Title

* 1. Contact Information

Question Title

* 2. Please provide the month and year for your data.For example, if you are reporting April numbers due by May 15th, you would respond with April.

Question Title

* 3. Dementia FriendsOnly provide data for Dementia Friends who have NOT become an online Dementia Friend to your knowledge.

* 2. Please provide the month and year for your data.
For example, if you are reporting April numbers due by May 15th, you would respond with April.

* 3. Dementia Friends
Only provide data for Dementia Friends who have NOT become an online Dementia Friend to your knowledge.