Post-Event Report Form

Quick Exit ✕

✅ Post-Event Report Form

Complete this report within 24 hours of your outreach event. Fields marked with * are required.

💡 Tip: Complete this form while the event is still fresh! Be sure to note any follow-up needs or referrals made during the event.

📅 Event Details

Event Date *

Actual Event Times *

Organization / Event Name *

Event Location / Venue

Presenter Name(s) *

📊 Attendance & Demographics

Total Number Attended *

Number of Presenters

Age Representation

Male Attendees

Female Attendees

Racial / Ethnic Representation

📌 Topics Presented (select all that apply)

Mental Health / 988 / Suicide Prevention Domestic Violence 911 Diversion ASL Videophone Homeless Services Information & Referral (2-1-1) Other

📦 Materials Distributed

CCSI Brochures Program Flyers Giveaway Items Referral / Hotline Cards

📝 Event Outcome & Follow-Up

Overall Event Summary *

Follow-Up Needed / Referrals Made

Challenges / Areas for Improvement

Would You Recommend Returning to This Event?

✍️ Submitted By

Your Name *

Your Email *

Date Submitted