The Conversation Project Community Activity Survey Q3 2019

Thank you for taking the time to help The Conversation Project learn about activity happening in your region to promote conversations! We are collecting this information on an on-going, quarterly basis and hope you will take a few minutes each quarter to share your progress with us! Once collected and sorted, we will share results back with you via our newsletter. We have created a template for you to collect this information on a monthly basis, if you need one. You can find it HERE.

Please answer the following about your work from July 1st, 2019, to September 30th, 2019.

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* 1. From July 1, 2019 to September 30, 2019: How many events/activities have you either presented at or hosted on the importance of conversations about advance care planning/end-of-life care? This includes in-person or virtual events (e.g. calls/webinars). And, this includes internal events (e.g. for your own staff) and external events (e.g. for those in your community)

# of events in July:

# of events in August:

# of events in September:

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* 2. From July 1, 2019 to September 30, 2019: If you've hosted or presented at event(s), how many were in attendance across all events combined (roughly)? For example, if you presented at ten events in July that each had ten attendees, note 100. If you hosted 3 sessions in August with the same 10 people at each session, note 30. Your best estimate is OK; doesn't have to be exact numbers!

Total # of attendees in July:

Total # of attendees in August:

Total # of attendees in September:

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* 3. From July 1, 2019 to September 30, 2019: If you’ve also shared specific TCP-related messages (e.g. any content, tools or resources highlighting the importance of conversations) through other mediums, please note roughly how many individuals you have reached below. Your best estimate is OK, doesn't have to be exact numbers! Please fill out only applicable fields.

# of TCP starter kits distributed that were not tied to an event:

# of individuals reached via a newsletter or email that contained TCP/conversation-related messages:

# of individuals reached via social media (e.g. if you reached 100 via a Facebook message, 100 via Facebook Live event and had 50 Twitter impressions, note 250):

# of individuals reached via other media events (e.g. if you reached 200 via podcast, had an audience of 1000 radio listeners and 1000 viewers of a TV spot, note 2200):

Additional comments on how you are reaching individuals (per above):

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* 4. As we develop new resources, share stories, and highlight new ideas from the field, what is your preferred way to find out about this new information?

Social media

Newsletter

TCP Website

Community calls

Other (please specify)

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* 5. Please provide any feedback you have about the above methods we use. (e.g. what you like or what you’d improve about the content, frequency or format of any of the above)

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* 6. For those new to TCP, how did you hear about/connect with us? (optional)

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* 7. Any comments/questions? Or please share any special projects, achievements, challenges, or lessons learned (optional)

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* 8. Your Name

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* 9. Your Organization's Name and/or Your Initiative's Name

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* 10. With what type of organization are you affiliated? (Please pick the affiliation that best describes your organization.)

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* 11. E-Mail Address

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* 12. In what zipcode are you or your organization located?

Thank you for your participation! If you haven’t already, connect with others doing similar work by adding your pin to our Conversation Champions Map.

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Please do not hesitate to contact us with any questions at conversationproject@ihi.org.