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Outreach Tracking Form

Please use this form to report HIV CTRS activities related to the National Youth Advocacy Coalition's "You Know Different" youth HIV testing initiative.

INDICATORS
2 Pre-Campaign Weeks
First Campaign Week
Second Campaign Week
Number of palm cards distributed
Number of posters distributed
Number of stickers distributed
Number of outreach contacts made

Distribution Venue - List all areas where the above items were distributed during the time periods:

Were any electronic materials utilized on agency website?    YES      NO

If yes please describe and provide link to material:

Your Name:

Organization Name:

City:

 

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