Healthy Communities Coalition Activity Promotion & Reporting Form If you are a human and are seeing this field, please leave it blank. Contact Name for this Activity Your Email Address Organization Are you promoting or reporting on an event? Promoting an eventReporting on an event Event or Activity Description Target of Activity TobaccoAlcoholOther DrugsViolenceTeen PregnancyPhysical ActivityNutrition Group Associated with Activity/Event ADAPTTeen Pregnancy PreventionPhysical Activity & Nutrition Date(s) and Times of Activity Involved in this Activity (# Expected or #Attended): Total Number of Adults - Males - Females - 18-24 - 25-54 - 55+ - White - Black/African American - Asian - Native Hawaiian or Other Pacific Islander - Hispanic - More than one race - Total Number of Youth - Males - Females - <4 - 5-8 - 9-13 - 14-17 - White - Black or African American Asian Native Hawaiian or Other Pacific Islander - Hispanic - More than one race - Thank you for providing this information. Click Submit to complete the form.
