2019 RESULTS Grassroots Media Report Form
This report notes and celebrates media achievements of you and your fellow advocates! Please fill out this form for each U.S. or global poverty media piece published or broadcast. Remember to send a copy of your media piece to your congressional offices, and share it on the RESULTS Listserv and/or RESULTS Volunteers Facebook page. Contact Jos Linn at jlinn@results.org if you have any questions.
Email address *
What's the name of your group, or are you a free agent? *
Your answer
What type of media did you get published or broadcast? *
What is the name of author or generator of the piece? *
Your answer
What kind of advocate is the author/generator of the piece? *
Date of publication/broadcast *
MM
/
DD
/
YYYY
Name of media outlet *
Your answer
In what state is the media outlet located?
Title of piece *
Your answer
Topic of piece *
Required
Please provide a link to the piece, if available *
Your answer
What is the name of the person filling out this report? *
Your answer
Who is your group's Regional Coordinator (RC)? *
Who did you send this media piece to in order to leverage it's impact (i.e. member(s) of Congress, Action Network)? *
Your answer
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