Virtual Community Service with Gift of Life Donor Program
Thank you for participating in our virtual community service opportunity. Gift of Life is a proud supporter of the high schools in our region, and we are pleased to offer this opportunity to the students in our communities. Students can earn up to 10 hours of documented community service through this program. The number of hours earned will be based on the quality of feedback provided. If you have any questions, please contact Gift of Life's Community Outreach Team at communityoutreach@donors1.org Thank you!
Part 1 - A License to Save Lives - Survey
This is a new program, and we want to know what you think about its overall design. Your meaningful feedback is appreciated, and will help us improve this program. You can earn between 1 - 5 community service hours for completing this part of the survey. The number of hours will be determined by the quality of feedback provided.
Overall opinion of the program A License to Save Lives:
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The program was easy to use.
The program was informative.
The program was interesting.
I enjoyed my experience with this.
The narration was clear.
I enjoyed the layout/design.
I enjoyed watching the videos in the program.
What were your favorite/least favorite aspects about A License to Save Lives:
Share your feedback on the videos, layout/design, and narration of A License to Save Lives
Additional comments/suggestions about A License to Save Lives:
Would you recommend A License to Save Lives to others?
Yes
No
Maybe
Part 2 - Information about Organ and Tissue Donation
This part of the survey focuses on the facts about organ and tissue donation. You can refer back to A License to Save Lives or visit www.donors1.org to find answers. If you are not sure of an answer and cannot find it, please make your best guess. You can earn between 1 - 5 community service hours for completing this part of the survey. The number of hours will be determined by the thoroughness of answers provided.
One organ donor can save up to how many lives?
3
5
6
8
List the organs that can be donated:
Examples of tissue that can be donated are:
skin
bones
corneas
all of the above
Name 2 other types of tissue that can be donated:
Approximately how many people are waiting for a life-saving organ transplant in the United States?
30,000
60,000
75,000
More than 100,000
I can only register as an organ and tissue donor at the DMV.
True
False
How else can someone register as an organ donor?
Being an organ donor does not affect medical care or funeral arrangements.
True
False
Organ and tissue donation is supported by all major religions.
True
False
If I choose to be an potential organ and tissue donor, I should:
Inform my family of my wishes
Learn the facts about organ and tissue donation
Say 'yes' to donation when I apply for or renew my license or state ID
All of the above
List 3 things that you learned from A License to Save Lives:
Explain why you think someone should or should not register as an organ and tissue donor.
When you receive your driver's license or state ID, will you register as an organ donor?
Yes
No
Undecided
I am already registered!
Is there anything about organ and tissue donation you would like to know that was not addressed in A License to Save lives?
Please write the name of the event where you received information about License to Save Lives and/or the organization who provided you with the information.
Congratulations! You've completed this community service opportunity!
Thank you for taking the time to provide meaningful feedback on A License to Save Lives. To receive documentation of your community service hours, complete the information below. If you provide a mailing address, we will send you a paper copy certifying your community service with Gift of Life Donor Program in addition to an email.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of High School
*
City and State of High School
*
Submit Survey
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