Step 1 of 3 - GENERAL INFORMATION 0% SECTION I: GENERAL INFORMATION1. NAME OF GRANTEE ORGANIZATION:* 2. CONTACT NAME:* 3. CONTACT PHONE:*4. EMAIL ADDRESS:* 5. DCED CONTRACT NUMBER:* SECTION II: FORM SUMMARY6. Provide an executive summary of services provided:*7. Provide the names of any partner organizations in your grant-supported vaccine efforts:*8. Coverage area of vaccine efforts (counties, municipalities, and/or ZIP codes):*9. Audiences targeted (vaccine-hesitant groups targeted by your efforts): Black/African Americans Healthcare and other essential workers Latinx LGBTQ community Low income persons Older adults (65 and older) Persons experiencing homelessness Persons less likely to use the Internet and others without Internet access Persons residing in rural or geographically isolated areas Persons who do not speak English fluently (or have limited English proficiency) Persons who have distrust in the government Persons with mental and/or physical disabilities Persons without a high school diploma Persons with underlying medical conditions (identified by CDC guidelines as high-risk conditions for COVID-19) Racial and ethnic minorities Refugees Undocumented immigrants (or recent immigrants) Youth and adolescents Young, mobile persons, including college students 10. Describe the grant-supported efforts of your organization to educate your community and reduce vaccine hesitancy:*11. Provide the total number of individuals serviced by the grant (Must be a single numeric value. If exact number is unable to be calculated, provide an approximate number):*12 A. Describe the work of your organization with local vaccine providers, such as pharmacies or health systems, to promote vaccine awareness and uptake:*12 B. List any successes and/or challenges of vaccine provider partnerships in reaching the high risk and underserved populations:*13 A. Describe the work of your organization to partner with other community organizations and other trusted sources to promote vaccine awareness and uptake:*13 B. Describe any challenges and/or successes/challenges of these local partnerships in supporting community engagement and vaccine promotion:* SECTION III: CONDITIONAL INFORMATION14. Were grant funds used for local media buys such as print, television, digital, and radio advertisements?* Yes No List approximate number of individuals reached by the media campaign:*15. Were funds used for designing and producing advertising, outreach, and training materials, including but not limited to: videos, digital content, direct mail, print materials (stickers, posters, flyers, etc.)?* Yes No List the number of materials that were distributed:*16. Were funds used for virtual vaccine-related events?* Yes No How many events were hosted?*Approximately how many total individuals attended all of the events combined?*Briefly describe the events:*17. Were funds used for in-person vaccine-related events?* Yes No How many events were hosted?*Approximately how many total individuals attended all of the events combined?*Briefly describe the events:*18. Were funds used for training community liaisons and outreach workers/volunteers?* Yes No List the approximate number of individuals trained:*HiddenREVIEWER NAME: HiddenDATE EMAIL SENT: MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.