Lewis University

Blood Donation Survey

Please take a moment to help us evaluate your participation in the process of donating blood. When youre done, please drop the questionnaire in the blue box at the front of the store.

Basic Information
Please note year in school:

How often do you donate blood?

Freshman Sophomore Junior Senior

Regularly Occasionally Rarely Never

Have you ever donated blood?

Have you participated in a blood drive at Lewis University?

Yes No

Yes No

Reasoning for Decisions

What is your reason for NOT donating blood?

Inconvenience Pain/needles Health issue Other issue:___________________

If you were to donate, what is the best time of day for you to do so?

Morning Afternoon Evening Night

If you DO donate blood, what is your reason?

Civil Duty Self-fulfillment For loved ones Other: _______________________

Would you be willing to listen to a speaker on the topic of donating blood?

Yes No

Additional Comments

________________
Would you be interested in receiving more information about donating blood at Lewis University?

Yes

No

Thank you for your participation! A prick in the arm is a small pain to endure for a beating heart.