Ambassador Information

Organization / Agency / Training Institution *
Ambassador Name *
Email *
Job Title
Month *
Year *

Outreach Activity 1

Activity Type
Description if "Other"
Activity Date
If your outreach activity was providing technical assistance at several points over the month or a promotional share of T.E.A.C.H. on your organization’s website, please enter the start date of the activity here. (e.g., %date_month_first_day%)
Activity End Date
Please list the end date of the activity here, if applicable. (e.g., %date_month_last_day%)
Number of Participants
(e.g., estimated # of individuals)
Audience Reached
(e.g., teachers, directors, potential scholars)
Outreach Method
Materials Distributed
(select all that apply)
Event Details
Note: Please use this field to provide any additional activity details information (e.g., Shared link to T.E.A.C.H. website or in monthly e-newsletter)

Outreach Activity 2

Activity Type
Description if "Other"
Activity Date
If your outreach activity was providing technical assistance at several points over the month or a promotional share of T.E.A.C.H. on your organization’s website, please enter the start date of the activity here. (e.g., %date_month_first_day%)
Activity End Date
Please list the end date of the activity here, if applicable. (e.g., %date_month_last_day%)
Number of Participants
(e.g., estimated # of individuals)
Audience Reached
(e.g., teachers, directors, potential scholars)
Outreach Method
Materials Distributed
(select all that apply)
Event Details
Note: Please use this field to provide any additional activity details information (e.g., Shared link to T.E.A.C.H. website or in monthly e-newsletter)

Outreach Activity 3

Activity Type
Description if "Other"
Activity Date
If your outreach activity was providing technical assistance at several points over the month or a promotional share of T.E.A.C.H. on your organization’s website, please enter the start date of the activity here. (e.g., %date_month_first_day%)
Activity End Date
Please list the end date of the activity here, if applicable. (e.g., %date_month_last_day%)
Number of Participants
(e.g., estimated # of individuals)
Audience Reached
(e.g., teachers, directors, potential scholars)
Outreach Method
Materials Distributed
(select all that apply)
Event Details
Note: Please use this field to provide any additional activity details information (e.g., Shared link to T.E.A.C.H. website or in monthly e-newsletter)

Outreach Activity 4

Activity Type
Description if "Other"
Activity Date
Please list the end date of the activity here, if applicable. (e.g., %date_month_last_day%)
Activity End Date
Please list the end date of the activity here, if applicable. (e.g., %date_month_last_day%)
Number of Participants
(e.g., estimated # of individuals)
Audience Reached
(e.g., teachers, directors, potential scholars)
Outreach Method
Materials Distributed
(select all that apply)
Event Details
Note: Please use this field to provide any additional activity details information (e.g., Shared link to T.E.A.C.H. website or in monthly e-newsletter)

No Activity

If you were unable to provide any T.E.A.C.H. outreach activity this month, please let us know and we can work together to increase access to potential scholars and sponsors in your area.
No Activity Details
Use this field to provide details or additional information (e.g., No activity for %date%. Our organization temporarily suspended in-person visits to local providers per health and safety.)