2. Contact Person
3. Address
4. Telephone Number
5. Fax Number
6. Email Address
7. Website
8. Today’s Date
9. Is your organization any of the following? Please check all that apply:
Academic institution Community-based Group Government Institution NGO (non-government organization)/Non-profit group Policy/Advocacy Group Public Health Clinic/Health Center Resource Center/Library Other (Please describe):
10. Please briefly describe the people/population your group serves (e.g. gender, age, rural/urban location):
11. How do you use this book(s)? Community outreach, organizing, or education Direct Service (Health work) Policy or advocacy Source material for publications Counseling For your own personal information Research Training of staff/personnel
12. Please briefly describe how you use it:
13. Please indicate which sections/chapters you find most useful by checking next to the appropriate chapter(s). Please check all that apply. This question applies to Our Bodies, Ourselves only. If you received a different book, please indicate which sections/chapters of the book(s) you received were most useful.
ONE: Taking Care of Ourselves
1 Body Image 2 Food 3 Alcohol, Tobacco, and Other Mood-Altering Drugs 4 Women in Motion 5 Holistic Health and Healing 6 Our Emotional Well-Being 7 Environmental and Occupational Health 8 Violence Against Women
TWO: Relationships and Sexuality
9 Working toward Mutuality 10 Relationships with Women 11 Sexuality
THREE: Sexual Health and Controlling Our Fertility
12 Understanding Our Bodies 13 Birth Control 14 Sexually Transmitted Diseases 15 HIV, AIDS, and Women 16 Unplanned Pregnancies 17 Abortion 18 Reproductive Technologies
FOUR: Child-bearing
19 Pregnancy 20 Childbirth 21 Postpartum 22 Child-bearing Loss, Infertility, Adoption
FIVE: Knowledge is Power
23 Women Growing Older 24 Selected Medical Practices, Problems, and Procedures 25 Politics of Women’s Health, Medical Care 26 Global Politics of Women and Health 27 Organizing for Change: USA
14. Please list the chapter titles (or numbers) of any chapters that you did NOT find useful/helpful:
15.If you received a different book from Our Bodies, Ourselves (e.g. Changing Bodies, Changing Lives; Ourselves, Growing Older; Sacrificing Ourselves for Love), please indicate which sections you found most helpful:
16. What do you think about the literacy levels of the materials included? too high too low appropriate
comments:
17. What do you think about the gender appropriateness of the materials for your group? appropriate not appropriate
18. What do you think about the cultural appropriateness of the materials for your group? appropriate not appropriate other:
19. What parts of the book are culturally appropriate for your public?
20. What parts of the book are unacceptable and/or inappropriate in your culture?
21. How do you use the book if it is not in your first language?
22. Please give us one or two specific examples of how this book has made a difference in your life or in the life of someone you work with. Has it made you or someone you work with behave differently (please describe)?
23. What is the most important piece of information from the book that you would share with the people you work with, a family member, or a friend?
24. If possible, please give an example of how this book is being used in any of the following ways: in a media presentation; to influence a policy affecting women; in a public education program/campaign; or other:
25. Do you know of another organization that would find our book(s) useful. Which book? Please provide name and address below:
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