2018/19 SKIIP Doses Administered Reporting Question Title * 1. Your name (First & Last): OK Question Title * 2. Your title: OK Question Title * 3. Your phone number (Cell phone is okay): OK Question Title * 4. Your email OK Question Title * 5. Your school district: APS Animas Public Schools Artesia Public Schools Aztec Municipal Schools Belen Consolidated Schools Bernalillo Public Schools Bloomfield Schools Capitan Municipal Schools Carlsbad Municipal Schools Carrizozo Municipal Schools Central Consolidated Schools Chama Valley Schools Cimarron Public Schools Clayton Municipal Schools Cloudcroft Municipal Schools Clovis Municipal Schools Cobre Consolidated Schools Corona Public Schools Cuba Independent Schools Deming Public Schools Des Moines Municipal Schools Dexter Consolidated Schools Dora Consolidated Schools Dulce Independent Schools East Mountain Public Schools Elida Municipal Schools Espanola Public Schools Estancia Municipal Schools Eunice Public Schools Farmington Municipal Schools Floyd Municipal Schools Fort Sumner Municipal Schools Gadsden Independent Schools Gallup-McKinley County Schools Grady Municipal Schools Grants-Cibola County Schools Hagerman Municipal Schools Hatch Valley Public Schools Hobbs Municipal Schools Hondo Valley Public Schools House Municipal Schools Jal Public Schools Jemez Mountain Public Schools Jemez Valley Public Schools Lake Arthur Municipal Schools Las Cruces Public Schools Las Vegas City Public Schools Logan Municipal Schools Lordsburg Municipal Schools Los Alamos Public Schools Los Lunas Public Schools Loving Municipal Schools Lovington Public Schools Magdalena Municipal Schools Maxwell Municipal Schools Melrose Public Schools Mesa Vista Consolidated Schools Mora Independent Schools Moriarty Municipal Schools Mosquero Municipal Schools Mountainair Public Schools Pecos Independent Schools Peñasco Independent Schools Pojoaque Valley Public Schools Portales Municipal Schools Quemado Independent Schools Questa Independent Schools Raton Public Schools Reserve Independent Schools Rio Rancho Public Schools Roswell Independent Schools Roy Municipal Schools Ruidoso Municipal Schools San Jon Municipal Schools Santa Fe Public Schools Santa Rosa Consolidated Schools Silver Consolidated Schools Socorro Consolidated Schools Springer Municipal Schools Taos Municipal Schools Tatum Municipal Schools Texico Municipal Schools Truth or Consequences Municipal Schools Tucumcari Public Schools Tularosa Municipal Schools Vaughn Municipal Schools Wagon Mound Public Schools West Las Vegas Public Schools Zuni Public Schools OTHER OK Question Title * 6. Name of school where clinic occurred (please report each school separately): OK Question Title * 7. Number of doses administered: OK Question Title * 8. Public Health Office that ran the clinic (if applicable): OK Question Title * 9. Date of the clinic: Date Date OK Question Title * 10. Duration of the clinic (in minutes): OK Question Title * 11. Number of staff that participated in the clinic: School nurse(s) Other school staff Public health nurse(s) Clinical volunteers (i.e.- nurses, pharmacists, clinical students) Other volunteers OK Question Title * 12. How well did the clinic go? Very poor Poor Average Good Excellent OK Question Title * 13. What could be improved next time? OK Question Title * 14. Other comments OK NEXT