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Event Tracking
1. Event Tracking Survey
Welcome to the new PHC event tracking system! We hope this new format will make it easier for you to record your activities on behalf of PHC. This information will be collected at the end of each month. Contact Andrea Smith with any questions or concerns.
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1
. What is the date of your event?
MM
DD
YYYY
Please enter the date of the event.
What is the date of your event? Please enter the date of the event. Month
/
Day
/
Year
*
2
. What is your name?
What is your name?
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3
. What is the name of the group for your event, or what is the name of the event you attended?
What is the name of the group for your event, or what is the name of the event you attended?
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4
. Who is the contact person for this group or event? Name, email, and phone if possible.
Who is the contact person for this group or event? Name, email, and phone if possible.
Contact Person
Email
Phone
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5
. Where was the event held?
Where was the event held?
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6
. What kind of event? If other is selected, please enter that in the comment field below.
Presentation
Training
Health Fair
Conference
Meeting
Other
What kind of event? If other is selected, please enter that in the comment field below.
Other (please specify)
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7
. What was the reason for the event, the topic of your presentation, or what service did PHC perform?
What was the reason for the event, the topic of your presentation, or what service did PHC perform?
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8
. How many people attended this event?
How many people attended this event?
Estimated Number
Exact Number
9
. Please make any comments you have here. You can evaluate the event, talk more about the type of event, make suggestions, or anything you would like the development department to know.
Please make any comments you have here. You can evaluate the event, talk more about the type of event, make suggestions, or anything you would like the development department to know.
*
10
. Was this event covered by the media? Enter the name of the media outlet in the section below.
Was this event covered by the media? Enter the name of the media outlet in the section below.
Yes - Des Moines Register or other Print Media
Yes - Radio Coverage
Yes - Television Coverage
No - No Media Coverage
I'm Not Sure
Name of Media Outlet
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11
. Should this event also be counted in the Enabling Services Grant?
Should this event also be counted in the Enabling Services Grant?
Yes
No
Not Sure
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12
. Did you have any volunteers to help you with this event? Please enter their names in the field below.
Did you have any volunteers to help you with this event? Please enter their names in the field below.
Yes, I had volunteers
No, I had no volunteers
Names of Volunteers
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