Project Prevent - Shareable Form
This form is intended to be completed by Project Prevent Youth Coalition (PPYC) Advisors or their representatives. Please read each question carefully before completing. Winners of the monthly PPYC Shareable Award will be selected by the Project Prevent Youth Coalition Youth Advocacy Board. Winners will be notified via email by the Project Prevent Youth Coalition Coordinator.
What is the name of your coalition? *
Who is the adult responsible for the coalition (PPYC Advisor, Hometown Health Coordinator, Teacher, etc.)? *
List the city and county in which the activity took place. *
What is the name of the Tobacco Prevention and Cessation Program (TPCP) Grant's Administrator associated with the coalition? (if applicable)
Select the start date for the activity. *
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Select the end date for the activity. *
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Briefly describe the activity's intended outcomes. *
Activity Outcomes: Describe the outcome(s) of the event. How many people were impacted? Of those impacted, how many were youth? Did the event achieve its intended results? Were there any unexpected champions, or partners, that worked with the coalition in order to carry out the event? Please provide as many details as possible about the outcome of the activity. *
Media: How was the event documented? Send pictures, photo releases, and any other documentation of the activity to Feather Linn at linnfn@archildrens.org. *
Reflection: How did the coalition reflect on the event and its outcomes? Create a list of actions that could be done differently if the project is carried out again. *
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