1. KFAP Activity Reports

Get credit for the activities you do!
Complete your activity report below.
Be sure to click "DONE" when you are finished.
Thanks for all you do!

* 1. Name

* 4. City or town (optional)

* 6. Email address

* 7. If you are a health department employee in Kentucky: Has this activity been reported in the health department's Community Health Services system?

* 8. What was the topic of the activity?

* 9. Please enter the date the activity was completed.

Activity date
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* 10. What was the site of the activity?

* 11. What type of activity did you do?

* 12. How many people did your activity reach? (Enter numbers only)

* 13. Description/comments: Please give a detailed description that will appear in the monthly report exactly the way you enter it.

Information to include:
* WHO did the activity
* WHAT was done
* HOW it was done
* TARGET AUDIENCE (include number of women of childbearing age)
* MATERIALS distributed (type and quantity)
* Source of FUNDING or any IN-KIND contributions
* Any other details of interest

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