Outreach Report Back Form

Please use this form to report back on your outreach conducted in-person utilizing the worker info cards and/or digitally utilizing the online toolkit. Below we have provided space to share information on up to five businesses, organizations, or groups you reach out to. If you reached out to more than five, please complete this form as many times as needed!

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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. How did you learn about this campaign?

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* 4. Please share your photos!

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* 5. Please provide information about the business, organization, or group you distributed campaign information to. This info will provide us with important metrics about the reach of this campaign.

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* 6. Please provide information about the business, organization, or group you distributed campaign information to. This info will provide us with important metrics about the reach of this campaign.

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* 7. Please provide information about the business, organization, or group you distributed campaign information to. This info will provide us with important metrics about the reach of this campaign.

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* 8. Please provide information about the business, organization, or group you distributed campaign information to. This info will provide us with important metrics about the reach of this campaign.

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* 9. Please provide information about the business, organization, or group you distributed campaign information to. This info will provide us with important metrics about the reach of this campaign.

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