Follow-Up Survey - Vaccinate Your Family

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 VACCINATE YOUR FAMILY program to educate parents and grandparents in your school community about the key role they play in protecting young children against vaccine-preventable diseases?

Yes
No

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

Yes
No

If YES, how many teachers?

3. Please evaluate these components of the VACCINATE YOUR FAMILY program.

Educator's Guide

Happy and Healthy Hands Coloring Activity

Letter to Parents

Letter to Grandparents

Wall Poster

4. Did you display the WALL POSTER?

Yes
No
Not yet

If YES, for how long?

5. Did you distribute the PARENT LETTER from Vaccinate Your Family?

Yes
No

If NO, why not?

6. Did you distribute the GRANDPARENT LETTER from Vaccinate Your Family?

Yes
No

If NO, why not?

7. Did you do the Happy and Healthy Hands Coloring Activity with children in your daycare center?

Yes
No

If NO, why not?

8. Would you be interested in receiving free vaccine-related educational materials in the future?

Yes
No

9. Have you visited the Vaccinate Your Family microsite (www.ymiclassroom.com/lesson-plans/vyf) to download or view any other teaching materials related to the program?

Yes
No

Please share any additional comments or suggestions.

Follow-Up Survey – Vaccinate Your Family

3. Please evaluate these components of the VACCINATE YOUR FAMILY program.