Dallas County Affiliate

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Current Results for Educational Materials Request Form

1. First Name

Total Number of Responses

227

2. Please select if you would like to request Breast Self-Awareness Cards (Maximum quantity - 25 total)

Value

 

Count

 

Percent

Yes

 

219

 

96.5

No

 

8

 

3.5

  

3. Please select if you would like to request "Breast Cancer Facts" (Maximum Quantity 15 total)

Value

 

Count

 

Percent

Yes

 

216

 

95.2

No

 

11

 

4.8

  

4. Please select if you would like to request "Men Can Get Breast Cancer" (Maximum Quantity 5 Total)

Value

 

Count

 

Percent

Yes

 

185

 

81.5

No

 

42

 

18.5

  

5. Will you need materials in Spanish?

Value

 

Count

 

Percent

No

 

176

 

77.5

Yes

 

51

 

22.5

  

6. If you are requesting Spanish language materials would you like all Spanish materials or a combination of English and Spanish?

Value

 

Count

 

Percent

User Provided No Response

 

173

 

76.2

Combination of English and Spanish

 

50

 

22.0

All Spanish

 

4

 

1.8

  

7. Please tell us more about the individuals who will receive these materials. Please check the appropriate buttons that describe your audience:

Total Number of Responses 224

Value

 

Count

 

Percent

African American

 

198

 

88.4

Age 40-49

 

169

 

75.4

Age 31-39

 

165

 

73.7

Age 50+

 

159

 

71.0

Age 18-30

 

151

 

67.4

Insured

 

139

 

62.1

Caucasian

 

133

 

59.4

Uninsured

 

132

 

58.9

Hispanic/ Latino

 

117

 

52.2

Asian American

 

77

 

34.4

  

8. Please explain how you will be using these educational materials.

Latest User Responses:

Women's Day Program for Breast Cancer Awareness. If you have pink ribbons pins or bracelets. How many can I have?
 

 

 

As knowledgeable tools to gain awareness for not only themselves, but their surrounding peers also!
 

 

 

We will be setting up an informational booth on campus at UTD to promote awareness of and raise support for breast cancer during this month of October.
 

 

 

We are having a ladies tea with the focus of breast cancer awareness and we anticipate 100 ladies in attendance. We are distributing informative gift bags that would include any information that you can provide. Thank you for your consideration.
 

 

 

As a dorm advisor I'm holding an educational program for around 60 people. We will be doing breast cancer awareness and going over informative topics for MALE breast cancer mainly, but all will be informed on everything.
 

 

 


View All Responses for question #8

9. Is this request for a church, temple, mosque or other place of worship?

Value

 

Count

 

Percent

No

 

149

 

65.6

Yes

 

78

 

34.4

  

10. Please include the name and address of the church, temple, mosque or other place of worship where these materials will be distributed.

Latest User Responses:

Holy Trinity Church of God In Christ
 

 

 

The event will be held in Lincoln Highschool Auditorium
 

 

 

User Provided No Response
 

 

 

Central Pointe CoC Mesquite Campus 1300 S Beltline Road Mesquite, Texas 75149 Please send to PO Box address noted above.
 

 

 

User Provided No Response
 

 

 


View All Responses for question #10