Shape Up SF Collective Impact Reporting: Physical Activity Workshops and Outreach Activities

Please enter the following information for every educational workshop, presentation, or outreach your organization has implemented to increase opportunities for physical activity since July 1, 2016.

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* 1. What organization are you with?

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* 2. What is your name?

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* 3. What is your email address?

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* 4. Date of the event?

Date

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* 5. Name and Location of Workshop/Presentation/Outreach

Name of Organization/Event

Location of Event

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* 6. Type of Event

Interactive Workshop (at least 30min, participants worked in groups and/or participated in activities)

Presentation/Lecture (minimal interaction/activities)

Health fair or Community Event/Outreach (e.g. Sunday Streets)

Physical Activity Class

Other (please specify)

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* 7. Frequency of Event

Daily

Weekly

Monthly

One Time Event

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* 8. Total number of participants/Persons reached

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* 9. Did any members of the following groups participate? (select all that apply)

Black, Latino, Asian, and/or API youth 11 and under

Black, Latino, Asian, and/or API youth 12-17 years old

Black, Latino, Asian, and/or API adults

Providers (health care, teachers, childcare, etc.) who work primarily with youth or adults who are Black, Latino, Asian, and API

None of the above

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* 10. For this specific activity, we want to understand if or how Shape UP SF contributed to making it happen:

	Agree	Disagree
This activity would not have happened if SUSF hadn't prioritized increasing opportunities for physical activity.	This activity would not have happened if SUSF hadn't prioritized increasing opportunities for physical activity. Agree	This activity would not have happened if SUSF hadn't prioritized increasing opportunities for physical activity. Disagree
This activity would not have happened without funding, TA, or other support/encouragement from SUSF.	This activity would not have happened without funding, TA, or other support/encouragement from SUSF. Agree	This activity would not have happened without funding, TA, or other support/encouragement from SUSF. Disagree

Any other comments about how Shape Up SF supported this activity.

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* 1. What organization are you with?

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* 2. What is your name?

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* 3. What is your email address?

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* 4. Date of the event?

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* 5. Name and Location of Workshop/Presentation/Outreach

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* 6. Type of Event

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* 7. Frequency of Event

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* 8. Total number of participants/Persons reached

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* 9. Did any members of the following groups participate? (select all that apply)

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* 10. For this specific activity, we want to understand if or how Shape UP SF contributed to making it happen:

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* 11. Additional Comments