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Form Test
Ambassador Information
Organization / Agency / Training Institution
*
Ambassador Name
*
Email
*
Job Title
Month
*
Select Month...
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Select Year...
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
Activities Performed?
Yes
No
If you were unable to provide any TEACH outreach activity this month, please let us know and we can work together to increase access to potential scholars and sponsors in your area.
Outreach Activities
Activity
Activity Type
Select Your Outreach Activity Type...
Advisory Board Meeting
Director Meeting
Center Visit / Community Outreach
Conference
Email
Phone Call
Provider Meeting
Social Media Post
Website
Workshop
Other
Description if "Other"
Activity Date
If your outreach activity was providing technical assistance at several points over the month or a promotional share of TEACH 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
Select Outreach Method...
In-Person
Virtual
Materials Distributed
TEACH Scholarship Model Booklets (Eng/Spn)
TEACH Scholarship Program Sponsor Flyers (Director/FCCH)
TEACH Rack Cards (Credentials/Renewals/College Credit/Degrees)
TEACH Swag Items / Giveaways
(select all that apply)
Event Details
Note: Please use this field to provide any additional activity details information (e.g., Shared link to TEACH website or in monthly e-newsletter)
×
Add new
No Activity
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.)
Submit
