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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 WDA.org. Send them to Emily Bultman at <ahref="mailto:ebultman@wda.org">ebultman@wda.org.

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* Dental practice name

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* # of years your dental office/component has particpated in GKAS®

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* Office address

Address:

Address 2:

City/Town:

State:

Zip:

County:

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* Contact Info

Office Phone:

Contact Name:

Contact Email:

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* WDA member name(s)
*Please list all particpating WDA member dentists and dental hygienists

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* Please indicate the following:

# of children seen

Approximate age(s) of patient(s)

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* Services provided

Conduct dental screenings

Provide sealants and/or fluoride rinse/varnish

Perform selected endodontic and surgical services

Visit school classrooms with oral hygiene presenations

Other (please specify)

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* Estimated final value of donated services

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* Number of support volunteers

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* Partnering organization(s)

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* 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 you invite one or more legislators to your GKAS® event?

Yes

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* Did one or more legislators visit your GKAS® event?

Yes

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* If yes, please provide legislators' names and visit details

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* What tools offered by the WDA did you use for your GKAS® event?

Legislator invitation

Legislator letter template

Media talking points

Letter to the editor template

Post-event press release template

Aware of tools, but did not use

Not aware of tools

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* 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.)

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* Do you plan to participate next year?

Yes

Not sure

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* Dental practice name

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* # of years your dental office/component has particpated in GKAS®

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* Office address

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* Contact Info

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* WDA member name(s)*Please list all particpating WDA member dentists and dental hygienists

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* Please indicate the following:

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* Services provided

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* Estimated final value of donated services

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* Number of support volunteers

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* Partnering organization(s)

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* Sponsor(s)

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* Did your event receive media coverage?

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

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* Did you invite one or more legislators to your GKAS® event?

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* Did one or more legislators visit your GKAS® event?

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* If yes, please provide legislators' names and visit details

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* What tools offered by the WDA did you use for your GKAS® event?

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* 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.)

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* Do you plan to participate next year?

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

* WDA member name(s)
*Please list all particpating WDA member dentists and dental hygienists