Your Name (required)

Your Title

Your Organization

Street Address (required)


(Suite #)

City

State

Zipcode

Phone (required)

Your Email (required)

Period covered by report

How are you connected to the issue of FASD?

Have you used any of the following tools in the advocacy kit?

Media Relations
 Key Messages Press Release Written Opinion-Editorial Letter to the Editor Desk-side Chat with Reporters Editorial Board Meetings Editorial Columns Media Advisories Public Service Announcements Community Calendar Blogs Friendly Reporter Research and Database Media Resource Directory Press Kits Broadcast Interviews Commemorations and Observances Mainstream Media

Community Outreach
 Organizational Engagement Event Participation Public Presentations Social Media Email Network (ListServ)

Torchbearer Recruitment
 Community-Action Summit DVDs Public Presentations Community Partnerships Email Network (ListServ) Key Messages Sample Press Release Sample Op-Ed Sample Letter to the Editor Sample Media Advisory Sample Public Service Announcement Media Submission Guidelines/Sample Pitch Messages Media Resource Directory Interview Tips and Guidelines Mainstream Daily Newspapers Mainstream Broadcast – TV Outlets Mainstream Broadcast – Radio Outlets Sample Newsletter Tabletop Display Campaign Brochure Campaign Flyer Frequently Asked Questions (FAQs) PowerPoint Presentation Sample Social Media Posts Torchbearer Interest Form Community Action Summit DVD

Please identify any additional Torchbearers recruited during this period:

Name

Street Address


(Suite #)

City

State

Zipcode

Phone

Email

Organization (if applicable)

What tools have you found to be most helpful and why?

Is there anything that is not currently provided that would help you in your outreach activities?

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