Outreach Report Form

Date

Volunteer/Staff Name*

Event/Org*

Name of the event or organization.

Hours*

Number of hours working outreach. Please enter two decimal points when recording half hours. For example: 1.50

# Disclosures*

Audience Demographics

Unless gathered though evaluation materials or audience's disclosures, this data is based on assumptions.

Table Visitors*

If this was not a tabling opportunity please enter 0 into this field.

Audience #*

Number of people in audience for speaking engagement. If you did not speak at an event please enter 0 into this field.

# Males*

# Females*

# Trans*-Identified*

# Youth*

# Adults*

# Black*

# White*

# Latinx*

# American Indian*

# Asian*

# Bi/Multiracial*

# People w/ Disabilities*

Materials Distributed

Check all of the OV materials disseminated at event. In paragraph below, list the numbers of all materials distributed. (e.g. 50 English OV brochures)

Type of Materials Distributed:

Hold "ctrl" to select multiple options

Number of Materials Distributed

Of the materials selected above, list the number of each material distributed (e.g. 50 OV English brochures)

Amount of Donations

You do not need to include a $ sign.

T-shirts sold

Price: $20.00 Quantity:

Number of t-shirts sold.

Outreach Report Form