What's your role/title?
When did you implement the “Get In Touch Girls’ Program?” / MM / DD YYYY
In what grade(s) were the girls receiving the program?
How many girls participated in the program?
Did you show the video from the website with the program? Yes No
Did the girls have any questions? Yes No
If yes, please give examples:
Do you feel the Daisy Wheel is self-explanatory? Yes No
Are you interested in the “Get In Touch Girls’ Program” for next year? Yes No
Please provide any feedback, suggestion or comments you would like to share with us.
May we use your comments, including your name, in our literature? Yes No
Would you be willing to speak with others interested in the “Get In Touch Girls’ Program” for their schools and/or communities? Yes No
Would your school be interested in hosting a National “GIT Your Pink On!” Dress Down Day on the third Friday in October to support the Get In Touch Foundation’s mission to provide the Get In Touch Girls’ Program to schools at no cost? (If yes, we will contact you and provide the information necessary to host this event.) Yes No
Name First Last
School
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email
Thank you for taking the time to complete this form. All of your information is very helpful for us to continue to offer and improve upon this program.

Thank you for taking the time to complete this form. All of your information is very helpful for us to continue to offer and improve upon this program.