Signup Header

Transplant Family Survey
The Children's Organ Transplant Association needs your help. Please complete this survey to help us better understand and meet the needs of our families and our partners. Your responses will help us review our resources and create additional tools for families, transplant professionals and volunteers. Thank you for your assistance.
 
Children's Organ Transplant Association (COTA) Services Please tell us your opinion of the services that COTA provides.
 
1.
Did you seek out information about fundraising to pay transplant-related expenses?
Yes
No
2.
How many organizations did you research?
One
Two or three
Four to six
More than seven
3.
Have you made a decision about working with an organization to raise funds for transplant-related expenses?
Yes
No
4.
Did you or will you call COTA to get information about fundraising?
Yes
No
5.
How did you find out about COTA (circle one)?
Hospital Social Worker
Hospital Transplant Coordinator
Hospital Financial Coordinator
Another Transplant Family
Publication
Web Search
Other  
6.
If you have already contacted COTA, please tell us about your experience:
 Excellent Very Good Good Fair Poor 
Speed COTA sent information to you
Understandability of the COTA materials
Helpfulness of the COTA materials
Were COTA services what you expected?
How well did COTA services match your needs?
7.
Did you receive a follow-up call from our office?
Yes
No
8.
Helpfulness of the follow-up call
Excellent Very Good Good Fair Poor       
      
9.
What could COTA have done to better meet your needs?
 

  • 500 character(s) left.
10.
If you have not contacted COTA, please tell us why (check all that apply)
I don't have volunteers
I don't want to raise funds in my community because I don't think they will respond
I don't want to ask people to help me raise funds
The COTA program is too complicated
I don't want to give up control of the funds raised
I don't plan to raise funds
I plan to work with another organization
I plan to work on my own
Other  
Your Needs: Please tell us more about your transplant situation.
 
11.
Has your transplant-needy family member received their transplant?
Yes
No
12.
What type of transplant?
 

  • 50 character(s) left.
13.
At what transplant center?
 

  • 50 character(s) left.
14.
Did you/will you do any fundraising to help with transplant-related expenses?
Yes
No
15.
If no, why not?
 

  • 350 character(s) left.
If you raised funds: Please share information about how you are addressing your transplant-related expenses.
 
16.
Are you working with an organization?
Yes
No
17.
Name of organization
 

  • 50 character(s) left.
18.
Would you refer other patients to this organization?
Yes
No
19.
How much did you raise/do you plan to raise?
$10,000 or less
$10,000 to $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 or more
20.
Were you happy with the amount raised?
Yes
No
21.
Did you feel you had adequate materials and resources for your fundraising activities?
Yes
No
22.
What resources did you wish you had available to you while you were fundraising?
 

  • 350 character(s) left.
23.
What types of fundraising activities did you/do you plan to do?
 

  • 350 character(s) left.
24.
Have you considered pr planned for possible tax implications or potential loss of benefits?
Yes
No
25.
Please describe your plan
 

  • 350 character(s) left.
26.
Would you advise other transplant patients to raise funds?
Yes
No
  • Comment:

  • 500 character(s) left.