Skip to content
This content is restricted to subscribers
View the Latest Community Health Events!
This content is restricted to subscribers
This content is restricted to subscribers
This content is restricted to subscribers
This content is restricted to subscribers
Partners
Photo Gallery
Contact
Log In
Search for:
This content is restricted to subscribers
Partners
Photo Gallery
Contact
Log In
Search for:
In-Person Event Reporting Form
portaourp
2023-05-01T09:40:57-05:00
In-Person Event Reporting Form
Please enable JavaScript in your browser to complete this form.
-
Step
1
of 3
Event Name/Title
*
Event Description
*
Event Start Date
*
Date
Time
Event End Date
*
Date
Time
Time Zone
*
EST
CST
MST
PST
HST
Event Venue
*
Venue / Event Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Venue Type
*
Church
Community Center
Community Event
DV Corporate Partner Site
FQHC Site
Health-Related Venue e.g. Hospital
Hotel / Conference Center
HPO Site
Large Fair / Event / Festival
Library
Non-Event Venue
Office Building
Parking Lot / Retail Location
Residence
School
Senior Center
Sports Facility
Street
Other
Target / Primary Population
*
Check all that apply.
Race: Black/African American
Race: Hispanic/Latino/Spanish
Race: Asian
Race: Middle Eastern/North African
Race: American Indian/Alaska Native
Race: Native Hawaiian/Other Pacific Islander
Race: White
Age: Under 18
Age: 18-24
Age: 25-24
Age: 34-44
Age: 45-54
Age: 55-64
Age: 65+
Age: Older Adults
Income: Low
Income: Medium
Income: High
Gender: Women
Gender: Sexual and Gender Minorities (LGBTQ)
Geo: Rural
People with Disabilities
Healthcare Providers
Researchers
Other
Audience Type
*
Participant
Researcher
Primary Purpose of Activity
*
Check all that apply.
Participant Recruitment
Participant Retention
Type of Activity
*
Check all that apply.
Outreach: Food distribution, flyer distribution, radio shows
Education: Workshop, presentation, seminar
Engagement: Festivals, health fairs
Enrollment: event specific for account creation and enrollment, Journey Bus event
Listening Sessions: covenings
Other
Number of Participants Outreached To
*
Number of participants at outreach event that received flyers, handouts, or other information related to AoU
Number of Participants Educated
*
Number of participants at education event
Number of Participants Engaged
*
Number of participants at engagement event
Focus
*
A primary focus is an activity dedicated to the All of Us program. An activity with a secondary focus supplements All of Us messaging with another topic.
Primary
Secondary
Please Specify "Other"
*
Next
If You Had Partners for This Event, Please Select Them
Check all that apply.
Direct Volunteer (DV) Site Partners
The Journey Bus or Mobile Engagement Asset
Health Provider Organization (HPO) Partners
Local Chapter / Organization / University
Local Businesses
Local Media Outlets
CPGI (Community and Provider Gateway Initiative)
National Community Engagement Partner - Asian Health Coalition
Faith-Based Organizations
NNLM (National Library of Medicine)
Other
If You Collaborated with All of Us HPOs, Please Select From the Following List:
Wisconsin - Marshfield Clinic Research Institute
Wisconsin - Blood Center of Wisconsin, Milwaukee
Wisconsin - University of Wisconsin School of Medicine and Public Health in Madison
California Precision Medicine Consortium - University of California San Diego (lead)
California Precision Medicine Consortium - Cedars-Sinai Medical Center, Los Angeles
California Precision Medicine Consortium - San Diego Blood Bank
California Precision Medicine Consortium - University of California, Davis
California Precision Medicine Consortium - University of California, Irvine
California Precision Medicine Consortium - University of California, San Francisco
California Precision Medicine Consortium - University of Southern California, Los Angeles
Illinois Precision Medicine Consortium - Northwestern University, Chicago
Illinois Precision Medicine Consortium - University of Chicago
Illinois Precision Medicine Consortium - University of Illinois at Chicago
Illinois Precision Medicine Consortium - North Shore University Health System, Chicago
Illinois Precision Medicine Consortium - Rush University Medical Center, Chicago
New England - Partners HealthCare System (lead) and its founding hospitals, Brigham and Women's Hospital and Massachusetts General Hospital
New England - Boston Medical Center
New England - Newton-Wellesley Hospital
New York City Precision Medicine Consortium - Columbia University Medical Center, New York City (lead)
New York City Precision Medicine Consortium - NYC Health + Hospitals/Harlem, New York City
New York City Precision Medicine Consortium - New York-Presbyterian, New York City
New York City Precision Medicine Consortium - Weill Cornell Medicine, New York City, New York City
Southern All of Us Network - University of Alabama at Birmingham (UAB)
Southern All of Us Network - Cooper Green Mercy Health Services, Birmingham, Alabama
Southern All of Us Network - Huntsville Hospital, Alabama
Southern All of Us Network - Louisiana State University Health Science Center, New Orleans
Southern All of Us Network - Tulane Medical Center, New Orleans
Southern All of Us Network - Tuskegee University, Alabama
Southern All of Us Network - UAB Hospital, Birmingham, Alabama
Southern All of Us Network - UAB School of Medicine's Montgomery Internal Medicine and Selma Family Medicine programs, Birmingham, Alabama
Southern All of Us Network - University of Mississippi Medical Center, Jackson
Southern All of Us Network - University of South Alabama Health System, Mobile
Southern All of Us Network - University Medical Center, Tuscaloosa, Alabama
SouthEast Enrollment Center - University of Miami Miller School of Medicine, Florida
SouthEast Enrollment Center - Emory University, Atlanta
SouthEast Enrollment Center - Morehouse School of Medicine, Atlanta
SouthEast Enrollment Center - OneFlorida Clinical Research Consortium led by the University of Florida in Gainesville
Trans-American Consortium for the Health Care Systems Research Network - Henry Form Health System, Detroit (lead)
Trans-American Consortium for the Health Care Systems Research Network - Baylor Scott and White Health, Dallas
Trans-American Consortium for the Health Care Systems Research Network - Spectrum Health, Grand Rapids, Michigan
Trans-American Consortium for the Health Care Systems Research Network - Essentia Institute of Rural Health, Minnesota
Trans-American Consortium for the Health Care Systems Research Network - Reliant Medical Group, Massachusetts
University of Arizona, Tucson - Banner Health, Phoenix
University of Pittsburgh at Pittsburgh
Federally Qualified Health Center - Cherokee Health Systems, Knoxville, Tennessee
Federally Qualified Health Center - Community Health Center, Inc., Middletown, Connecticut
Federally Qualified Health Center - Eau Claire Cooperative Health Center, Columbia, South Carolina
Federally Qualified Health Center - HRHCare, Peekskill, New York
Federally Qualified Health Center - Jackson-Hinds Comprehensive Health Center, Jackson, Mississippi
Federally Qualified Health Center - San Ysidro Health, San Ysidro, California
Vanderbilt University
VA Medical Centers
Attendees/ Audience Size
*
Type of Activity
*
Non-Digital
Non-Digital Activities
*
Booth/Exhibit
Print Distribution/Advertising
Speaker/Presentation
Topical Session/Workshop
Other - Non-Digital
Previous
Next
Attendees/Audience Size
*
Non-event metrics could include email deliveries, webpage visits, or other equivalent measures of total activity audience.
Visits
*
Similar, to engagements, this is the total number of visitors your booth/table/exhibit received during an event. If your booth received 1 visitor who asked 3 questions, you might log that as 1 Visit and 3 Non-Digital Engagements.
Non-Digital Engagements
*
The number of times you engaged with an individual during a non-digital event.
Distributed
*
The number of times you engaged with an individual during a non-digital event.
Attendees/Audience Size
*
Non-event metrics could include email deliveries, webpage visits, or other equivalent measures of total activity audience.
Non-Digital Engagements
*
The number of times you engaged with an individual during a non-digital event.
Attendees/Audience Size
*
Non-event metrics could include email deliveries, webpage visits, or other equivalent measures of total activity audience.
Non-Digital Engagements
*
The number of times you engaged with an individual during a non-digital event.
Brief Description
*
Attendees/Audience Size
*
Non-event metrics could include email deliveries, webpage visits, or other equivalent measures of total activity audience.
Non-Digital Engagements
*
The number of times you engaged with an individual during a non-digital event.
Calls-to-Action
*
Bitly Link/QR Code
Vanity URL
Download App
Provide email address
Please specify the Bitly URL
*
Total Bitly Clicks/Scans
*
Please specify the Vanity URL
*
Total Vanity Clicks/Referrals
*
Total App Referrals
*
Total Emails Collected
*
Activity Attributes
*
Community Resource Program (CRP)
Distributed giveaways (non-printed, branded materials like t-shirts/water bottles)
"Elevate" Campaign
Involved elected officials
Provider event with CME/CE credit
Provider event without CME/CE credit
Virtual Ambassador Program (VAP)
How many total items did you distribute?
*
How many attendees received CME/CE credit?
*
What Elements of Your Activity Were Successful?
*
What Elements of Your Activity Were Not Successful?
*
Upload Photos From This Event
Click or drag files to this area to upload.
You can upload up to 30 files.
Previous
Submit
Page load link
