*Please note that all customized/translated promotional materials for the AoURP must be approved by the Asian Health Coalition prior to planned activities/events.*

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* 1. Name of Organization

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* 2. Event Name/Title 

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* 3. Activity Scope/Reach

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* 4. Activity Type

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* 5. Event Start Date

Date
Time

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* 6. Event End Date

Date
Time

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* 7. Venue Name

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* 8. Venue Type

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* 9. Venue Address

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* 10. Event City

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* 11. Event State

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* 12. Event Zip Code. If online, type "online".

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* 13. Communities/populations reached (select all that apply):

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* 14. Please list the languages spoken during your event (select all the apply):

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* 15. Type of Outreach/Recruitment Event (Select all that apply):

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* 16. Method of promotion prior to event (select all that apply):

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* 17. Tactics and strategies used during the event (Select all that apply):

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* 18. What value propositions/messages resonated most, and why?  What messages do you think were well received and inspired by attendees? (Select all that apply):

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* 19. What concerns have people expressed about the program? (Select all that apply):

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* 20. What barriers to participation have been mentioned by participants?

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* 21. Please list three key lessons learned.

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* 22. Please provide three testimonials (quotes) from attendees. You may mention first names of individuals.

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* 23. Estimated number of attendees at the event:

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* 24. Estimated number of attendees you have engaged with and educated at the event:

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* 25. Estimated number of attendees by age:

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* 26. Estimated number of attendees based on self-identification:

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* 27. Facilitating Enrollment

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* 28. If you had partners for this event, please select them:

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* 29. If you collaborated with All of Us HPOs, please select from the following list:

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* 30. Overall, how would you rate the partnerships on helping you to meet your event objectives?

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* 31. Overall, how would you rate this event?

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* 32. Have you uploaded photos from the event to PORT?

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* 33. Before submitting this survey, did you print it or save it as a PDF file for your records?

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