Follow-Up Survey - Connecting Kids to Medicaid and CHIP Coverage

Name*

First Last

Email*

School*

Address*

Street Address City State ZIP Code

Grades you teach:

1. Have you used (or do you plan to use) the CONNECTING KIDS TO MEDICAID AND CHIP COVERAGE health program?

2. Did you (or do you plan to) share this program with other teachers?

If YES, how many teachers?

If NO, why not?

3. Please evaluate these components of the program.

School Champion Letter

Family Letter in English/Spanish

Microsite Resources at ymiclassroom.com/insurekidsnow

4. Did you download and distribute the Family Letter?

If YES, which version?

5. Overall, how would you rate the usefulness of the CONNECTING KIDS TO MEDICAID AND CHIP COVERAGE program?

6. Please estimate how many of your students' families were reached with this program.

7. Have you visited YMI’s website (www.ymiclassroom.com) to download any other teaching materials?

If YES, which materials?

Please share any additional comments or suggestions.