BEACON Reporting Form

established? Discussed Date

Organization Name *

Event Name/ Title *

Event Start Date *

Date

Time

Event End Date *

Date

Time

Time Zone *

Event Location *

Event Format *

Event Type Descriptions:

Health Education Event: provides information and resources to help individuals better understand health topics and healthy behaviors. Examples include webinars, workshops, presentations, etc.

Health Fair: community-focused event that brings together community organizations, healthcare provider organizations, and resources all in one location. May include activities such as free health screenings, education materials, immunizations, and opportunities to connect with local health and social service providers.

Outreach Event: designed to engage community members, increase awareness of prorgrams or services, and build connections with individuals who may benefit from available resources. Examples include tabling at public libraries, handing out flyers at community event, etc.

Please choose the event type that best fits: *

If Other, please describe event type *

Health Topic(s) Discussed *

If Other, please describe health topic discussed *

Estimated Attendance *

Priority Population(s) Reached *

If Other, please describe population reached *

Asian Ethnicities Reached *

If Other Asian Ethnicity, please list *

Native Hawaiian or Pacific Islander Ethnicities Reached *

If Other Pacific Islander Ethnicity, please list *

BEACON Reporting Form

Event Type Descriptions:

Please remember to upload these appointments and referrals to the ICC Portal.