Instructions for Completing the Marquette County Coalition on Substance Abuse and Violence Prevention Coalition
Members Activities Tracking Sheet - November 2002
NOTE: IF YOU HAVE SUBMITTED SIMILAR IN FORMATION TO PATHWAYS SUBSTANCE ABUSE PREVENTION SERVICES, YOU DO NOT NEED TO INCLUDE THOSE ACTIVITIES IN THIS REPORT.
Month and Year: Please write in the period covered for this report
Agency Name: Write in the name of your agency.
Detailed Activity Description: Please write in the activity performed. Be as specific as possible so that we can relate it to one of the six strategies and appropriate goal/objectives. (refer to the Strategy /Goals and Objectives Sheet for more information). Note: If the service/activity is reoccurring, for example if it occurs once a week for the month, put it in four times.
Target population: Please write in the audience this activity touched; Ex: youth, elders, school personnel, etc.
Event Date: Write in the date the activity occurred.
Number in Attendance: Write in the number of persons who attended the activity.
Strategy Designation: On the reverse side of the reporting form is a description of the strategies and goals. Please write in the Number(s) of strategy(s) that matches the activity being reported. Please refer to the Strategy/ Goals and Objectives Sheet for more information.
Please Fax: (906-228-2469) or email: lziomkow@dioceseofmarquette to Larry Z.