Give Kids A Smile 2013® - Post-Event Evaluation

Thank you for participating in Give Kids A Smile® 2013!

More than 9,500 low-income children were smiling thanks to Wisconsin dentists and dental professionals participated Give Kids A Smile® 2013. An estimated $1.2 million in dental care was donated on Feb. 1, and during the following weeks, as part of the 11th annual national children's dental access program.

Help the Wisconsin Dental Association track final data from your GKAS® events to share with legislators and news media by filling out this brief post-event form. Your comments will also help us identify new ways to support local event planning and implementation for 2014.

Digital photos from your event are welcome for publishing in the WDA Journal and on Send them to Emily Bultman at
Image as described above
Dental practice name
# of years your dental office/component has particpated in GKAS®
Office address
Contact Info
WDA member name(s)
*Please list all particpating WDA member dentists and dental hygienists
Please indicate the following:
Services provided
Estimated final value of donated services
Number of support volunteers
Partnering organization(s)
Did your event receive media coverage?
If so, please provide details of the media coverage.
Did you invite one or more legislators to your GKAS® event?
Did one or more legislators visit your GKAS® event?
If yes, please provide legislators' names and visit details
What tools offered by the WDA did you use for your GKAS® event?
How can the WDA better help you with GKAS® 2014? (Please keep in mind the WDA is not a dental supply company and does not have supplies to give away.)
Do you plan to participate next year?
Is there any additional information you would like to share with staff or WDA Journal readers?
Powered by SurveyMonkey
Check out our sample surveys and create your own now!