Form

Alliance for Period Supplies Data Collection 2023-2024

The Junior League of Tampa Alliance for Period Supplies committee collects monthly data from its distribution partners to better understand community needs and impact.

Please answer the following questions to the best of your ability. Leave blank any data collection points for which we previously agreed in the MOA your organization would not provide.

Upon submission, you will be able to access your monthly order form.

Organization Name

Period Product Distribution

Number of period products distributed annually (beginning in August 2022)

Number of individuals receiving period products from you program annually (beginning in August 2022)

Number of period products distributed in the last month

Number of individuals receiving period products from your program in the last month

List your agency program through which period products were distributed last month

Demographics

Did your organization distribute period products to individuals in the following areas? Check all that apply.

Balm

Ruskin

Wimauma

Other

If your organization was exempted from providing certain data points, please insert 0 as the answer.

Percentage of individuals under age 10 served last month

Percentage of individuals aged 11-18 served last month

Percentage of individuals older than 18 severed last month

Percentage of Hispanic or Latino individuals served last month

Percentage of American Indian or Alaska Native individuals served last month

Percentage of Asian individuals served last month

Percentage of White individuals served last month

Percentage of Black or African American individuals served last month

Percentage of Middle Eastern or North African individuals served last month

Percentage of Pacific Islander individuals served last month

What percentage of individuals served last month live at or below the federal poverty line?

Additional Information

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