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Women in Insurance: Day of Action, Data Collection Form
Please use the form below to track data surrounding your "Day of Action" activities.
Tracking your data and activities will help the Women in Insurance Initiative better measure the impact of this event.
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* Indicates required question
First & Last Name
*
Your answer
Organization
*
Your answer
Job Title/ Role
*
Your answer
Email address
*
Your answer
Activity
*
In Person Presentation
Virtual Presentation
Individual Discussion
Career Fair
Mentoring Conversation
Promotion via your network
Other:
Required
Type of Organization(s) You Reached Out To
*
University
Community College
High School
Student Activities Club
N/A (Not Applicable)
Other:
Required
Name of School(s) or Organization(s) You Reached Out To — write N/A if this does not apply
*
Your answer
Number of People Reached
*
Your answer
Number of Hours Invested
*
Your answer
Would you be interested in doing this type of outreach or another Day of Action in the future?
*
Yes
No
Maybe
What would you add to make this more effective in the future?
Your answer
Observations or Comments?
Your answer
Are you interested in learning more or getting involved with the Women in Insurance Initiative?
*
Yes
No
Other:
Do you know anyone in your network who would like to potentially participate in future WII activities?
Please include their names, organizations, roles, and contact information (email address preferred)
Your answer
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