All sponsored community groups and organizations are required to complete and return this evaluation document so that the success of the partnership can be evaluated.  Please fill this out within 90 days of your event or based on your agreed upon arrangements with Hattiesburg Clinic.  Thank you for allowing Hattiesburg Clinic to help make our community better!

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* 1. Organization:

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* 2. Event/Project Title:

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* 3. Date of Event/Project:

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* 4. Name (First & Last):

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* 5. Position:

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* 6. Address:

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* 7. Email:

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* 8. Phone number:

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* 9. Hattiesburg Clinic is committed to supporting initiatives that support health, education and economic development. Please indicate what initiative this event/project supported:

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* 10. What was the purpose and goal of this event/project? How were those goals reached?

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* 11. How were the funds used? Please be specific and list all purposes:

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* 12. Please explain how Hattiesburg Clinic's participation impacted the outcomes of this event/project:

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* 13. What was the attendance for this event/project? Please provide a comparison of the past (5) years if applicable. (or if less than 5 please provide from beginning and chart):

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* 14. Who was your target audience? Please explain:

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* 15. Was Hattiesburg Clinic mentioned as a sponsor?

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* 16. Please include a breakdown of channels, reach, impressions, or other analytics for your event.

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* 17. What was the direct impact of this event/project to the community? In other words, please explain your outcomes:

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* 18. Please provide any additional details and/or feedback that you would like Hattiesburg Clinic to know:

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