Chasing the Dragon Survey
Name of School *
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City *
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Teacher's Name *
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I am: *
Please write a brief paragraph explaining how viewing Chasing the Dragon made an impact in your life. *
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Do you believe viewing Chasing The Dragon is a beneficial activity for students and community members? *
How beneficial was the group discussion after the film? *
Not At All
Extremely Beneficial
If you received additional printed resources concerning Arkansas Opioid Addiction data please rate the usefulness of the information. *
Not At All
Extremely Beneficial
Do you desire additional information or contact concerning information revealed in Chasing The Dragon?
If Yes, please provide your Name and Email address below:
Full Name (optional)
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Email Address (optional)
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Please check the topics below that you would like similar types of discussions or materials available concerning the areas
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