The following information should be reported by the events Lead Facilitator. Please contact Madison MacLean (madison_maclean@jsi.com) with questions.

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* 1. If your event was for a specific County, please choose it from the drop-down menu. If not, please skip to Question 2.

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* 2. If your event was for a specific community, please select it from the drop-down menu.

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* 3. Name of event

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* 4. Date of event

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* 5. If the event was held in person, report the name and location of the venue.

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* 6. Number of participants

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* 7. Lead facilitators' name(s)

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* 8. Lead facilitators' email(s)

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* 9. List the organizations represented at this event

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* 10. List the indicators identified as concerning by your participants, and the number of times those indicators were mentioned (e.g., e-cigarette use by middle school students – 3 votes; days missed due to poor health – 4 votes).

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* 11. List the top four Health Priority Topic Areas identified at this event, along with the total number of votes, in ranked order.

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