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Leadership Volunteer activity report form
Leadership Volunteer activity report form
share_your_story
Name
(Required)
First
Last
Email
(Required)
Which Leadership Volunteer Program are you a part of?
(Required)
Young Advocate (current class)
Hear My Voice (current class)
Leadership Volunteer Alumni
What was the date of your activity?
(Required)
MM slash DD slash YYYY
What activity type did you participate in?
(Required)
Distributed LBBC materials at a community event
Shared LBBC materials with a healthcare provider
Hosted a fundraiser for LBBC
Served as a monthly host on an LBBC Facebook Support Group
Posted on social media
Attended an event or conference
Wrote a blog
Spoke at an event or conference
Was interviewed by the media (newspaper, TV, website, other)
Participated in legislative, scientific, or research advocacy
Provided peer support to someone diagnosed with breast cancer
Other
Was the activity in-person or virtual?
(Required)
In-person
Virtual
Please describe the activity:
(Required)
If the activity has a website or video, please provide the link here:
If you have photos from your activity, please upload 1-3 photos. (.jpg or .png only)
Drop files here or
Select files
Max. file size: 50 MB.
If this activity was an LBBC fundraising event, how much money did you raise?
How many hours did you spend on this activity? Include preparation and travel time.
(Required)
Please enter a number greater than or equal to
0
.
Please provide an estimate of the number of people you reached. (Enter a number from 1 to 5000. Please enter 5000, for more than 5000.)
(Required)
Please enter a number less than or equal to
5000
.
On a scale of 0 to 10, please rate your overall experience for this activity. (10 being a fantastic experience that you would recommend to others, 0 being a terrible experience that wasn't worthwhile at all)
(Required)
Please enter a number from
0
to
10
.