1999 REPORT FORM: TELL US WHAT YOU DID!
Here is your chance to let us know about your World Mental Health Day celebration! We are eager to learn what you did and to include your effort as part of the global record of activities compiled each year by our office. Please fax or post this form by November 30, 1999 to the address below. At your convenience, please also send any photographs, articles, or World Mental Health Day promotional materials. Thanks for your prompt response, we are looking forward to hearing from you.
Fax or post by November 30, 1999 to:
Pam McKinley, World Federation for Mental Health
1021 Prince Street, Alexandria, VA 22314 USA
If you have any questions, contact Pam McKinley at
tel: 703 838-7525; fax: 703 519-7648;
e-mail: [email protected]
(PLEASE PRINT)
YOUR COUNTRY:___________________________________________
Is your organization a member of the World Federation for Mental Health?
YES – NO
Are you an individual member of the World Federation for Mental Health?
YES – NO
To verify our mailing list, please provide your current address below:
Name_______________________________________________
Organization_________________________________________
Address_____________________________________________
Address_____________________________________________
Phone Number____________________________________
Fax Number______________________________________
E-Mail____________________________________________
1. Overall, how satisfied were you with the World Mental Health Day Planning Kit?
VERY SATISFIED – SATISFIED – NEUTRAL
DISSATISFIED – VERY DISSATISFIED
COMMENTS:
______________________________________________________
______________________________________________________
______________________________________________________
2. How satisfied were you with the arrival of the kit in time to plan your activities?
VERY SATISFIED – SATISFIED – NEUTRAL
DISSATISFIED – VERY DISSATISFIED
COMMENTS:
______________________________________________________
Do you have any ideas on helpful information that could be included in next year’s kit?
______________________________________________________
______________________________________________________
______________________________________________________
3. Is your highest woman leader (first lady, member of royalty, or head of state) a member of the International Women Leaders for Mental Health Committee?
YES – NO
If YES, did you seek her participation in your World Mental Health Day events?
YES – NO (Use additional pages if necessary.)
4. Did you hold any proclamation-signing ceremonies?
YES – NO
If yes, please describe:
______________________________________________________
______________________________________________________
5. What special events did you hold to observe World Mental Health Day? (Use additional pages if necessary.)
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
6. Did you use this years theme, Mental Health And Ageing in your activities?
YES – NO
Please describe.
______________________________________________________
______________________________________________________
7. How many people participated in your event? _________
8. On a scale of 1 to 10, please rate the impact of your World Mental Health Day activities upon the following areas:
Increased public understanding of Mental Health And Ageing issues:
1 2 3 4 5 6 7 8 9 10
Improved public awareness of the mental health services currently available in your community:
1 2 3 4 5 6 7 8 9 10
Enhanced inter-generational communication, resulting in a healthier community:
1 2 3 4 5 6 7 8 9 10
9. Please list your local news coverage for World Mental Health Day. Include the names of newspapers, magazines, radio and television stations. (Use additional pages if necessary.) At your convenience, please send us copies of articles.
Newspapers and Magazines (articles and announcements):
Radio and Television (stories and interviews):
10. If you were to choose the one outcome that you are most proud of accomplishing through your World Mental Health Day event this year, what would it be and why? (Use additional pages if necessary.)
_______________________________________________________
_______________________________________________________
_______________________________________________________
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WFMH needs your professional quality photographs (black & white and full colour) of World Mental Health Day events — to be used in our publications and as website illustrations. |
Do you know of others who would be interested in obtaining a copy of the 2000 World Mental Health Day Planning Kit? Provide their names and addresses below:
| (PLEASE PRINT)
Name_____________________________________________ Organization_______________________________________ Address___________________________________________ Address___________________________________________ Phone Number_____________________________________ Fax Number_______________________________________ E-Mail_____________________________________________ |
| (PLEASE PRINT)
Name_____________________________________________ Organization_______________________________________ Address___________________________________________ Address___________________________________________ Phone Number_____________________________________ Fax Number_______________________________________ E-Mail_____________________________________________ |
Thank you for filling out and returning this Report Form.
We appreciate your response!