SurveyMonkey Powered Online Survey

Thank you for participating in GKAS 2010! You are helping improve the dental health needs of large numbers of needy children while raising awareness of the challenges many families face in accessing dental care.

Help us track final data from your GKAS event to share with legislators and news media by filling out this brief post-event form. Your comments also help us identify new ways to support local event planning and implementation next year.

The information you provide here will also be used in communications with news media and legislators.

Digital photos from your event are welcome for our online photo gallery! Send them to Communications Coordinator Emily Bultman at ebultman@wda.org.

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* Dental practice name

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* Office address

Address:

Address 2:

City/Town:

State:

ZIP:

County:

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* Contact info

Office Phone:

Office Fax:

Contact Name:

Contact E-mail:

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* Please indicate the following:

Final number of children seen

Approximate age(s)

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* Services provided

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* Estimated final value of donated services

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* Name(s) of participating dentist(s)

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* Number of support volunteers

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* Contributing organization(s)

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* Name(s) of additional sponsor(s)

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* Did your event receive media coverage?

Yes

Not sure

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* If so, please provide details of the media coverage.

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* Did one or more legislators visit your event?

Yes

Not sure

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* If so, please provide details of your legislator(s) visit.

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* What, if any, tools offered by the WDA did you find helpful for your GKAS event?

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* How can the WDA better help you with next year's program? (Please keep in mind the WDA is not a dental supply company and does not have supplies to give away.)

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* Do you plan to participate next year?

Yes

Not sure

Give Kids A Smile 2010 - Post-Event Evaluation

Question Title

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* Dental practice name

Question Title

* Office address

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* Contact info

Question Title

* Please indicate the following:

Question Title

* Services provided

Question Title

* Estimated final value of donated services

Question Title

* Name(s) of participating dentist(s)

Question Title

* Number of support volunteers

Question Title

* Contributing organization(s)

Question Title

* Name(s) of additional sponsor(s)

Question Title

* Did your event receive media coverage?

Question Title

* If so, please provide details of the media coverage.

Question Title

* Did one or more legislators visit your event?

Question Title

* If so, please provide details of your legislator(s) visit.

Question Title

* What, if any, tools offered by the WDA did you find helpful for your GKAS event?

Question Title

* How can the WDA better help you with next year's program? (Please keep in mind the WDA is not a dental supply company and does not have supplies to give away.)

Question Title

* Do you plan to participate next year?

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* Is there any additional information you would like to share with WDA Journal readers?