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* 1. Please note the specific date range of your activities for this month

Note: Please use this format MM/DD/YYYY - MM/DD/YYYY

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* 2. Partner Organization Name

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* 3. Which grant are you completing this survey for?

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* 4. Number of community outreach workers hired to date

Note: This number should reflect the total number of CHW and other types of outreach workers that your organization has hired as of the start of the project period. This includes workers that are currently employed, contracted, or volunteering.

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* 5. Total number of community outreach workers that were hired and are no longer employed/contracted/volunteering.

Note: This number should reflect the total number of CHWs and other types of outreach workers that your organization is no longer employing/contracting/volunteering. This may be due to attrition, expiration of employment contracts, etc. This number should be less than the total number of CHW and other types of outreach workers hired.

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* 6. Total number of individuals hired from the communities served by this project to date.

Note: This number should reflect the total number of CHWs and other outreach workers that your organization has hired from the communities served by the project as of the start of the project period.

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* 7. Total number of individuals who received assistance under this project in THIS month.

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* 8. Total number of individuals who received vaccine outreach and education information in THIS month.

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* 9. Total number of individuals who received a vaccine in THIS month.

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* 10. Please provide a narrative of this month's activities.

Thank you for filling the Monthly Progress Report! If you have any questions relating to this, please contact ALL of the following:

Nashia Choudhury, Associate Director of Workforce Development: nchoudhury@aapcho.org
Julia Liu, CHW Data Lead: jliu@aapcho.org
Vanessa Wan, Program Coordinator: vwan@aapcho.org

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