Cancer Champions Supervision

Date / Time *

Volunteer Name *

First

Last

How or if

How have you been since we last spoke? *

How many conversations about cancer have you had over this period?

How confident do you feel about having these conversations?

1 - Not Confident	2 - Fairly Confident	3 - Confident	4 - Very Confident	5 - Extremely Confident
1 - Not ConfidentItem #1 1 - Not Confident	2 - Fairly ConfidentItem #1 2 - Fairly Confident	3 - ConfidentItem #1 3 - Confident	4 - Very ConfidentItem #1 4 - Very Confident	5 - Extremely ConfidentItem #1 5 - Extremely Confident

Have you faced any challenges?

Have you used any of the campaign resources or materials recently?

Is there any training or information that would help you feel more confident?

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