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* 1. Please provide your name

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* 2. Please provide your email

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* 3. I am a... 

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* 4. How did you hear about the Epilepsy Toronto Purple Day Classroom Kit (please select all that apply)?

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* 5. What is the name of the school(s) that you brought the Purple Day Kit to?

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* 6. What grade(s) was the program presented to?

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* 7. How many students participated in the program?

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* 8. Which elements of the classroom kit did you make use of (please select all that apply)?

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* 9. How satisfied were you with the content presented in the Purple Day Kit(s)?

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* 10. Do you have any other comments, questions, or additional feedback?

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