Personal Quitting Story form

Quitting smoking takes a lot of inner strength, determination, and courage. We are finding that when people share their quitting stories, it gives others encouragement to try and quit as well. It is our hope at CASE that by sharing the quitting stories of willing volunteers like yourself, we might be able to help others find the courage to break their addiction and lead healthier, more productive lives. When you fill out and submit this form, you are giving Student Health & CASE permission to use your story of strength and perseverance to motivate and help others.

Today's Date:

Your Name (Last, First):

Your Title

Your Organization or University

E-mail:

Hints for writing an interesting story: Provide us with just a little bit of background information using the questions below. If you write a few lines addressing each question you will have a nice inspiring testimony. If you have any questions, send an e-mail to: andersendc@health.missouri.edu.

1. How old are you now?

2. How old were you when you started smoking?

3. What made you decide to start smoking?

4. How did you feel about yourself as a smoker?

5. When did you realize you were addicted?

6. What made you decide to quit smoking?

7. What was easy and/or hard about quitting for you?

8. How do you feel about yourself now that you have quit smoking?

Congratulations, and thanks again for volunteering to help us provide support and outreach to others.