Name of Community Team/Organization:
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Name of Primary Contact(s):
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Primary Phone Number(s):
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Members of your StoryMakers Community Team (other than primary contacts) and email:
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Shipping Address:
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Please confirm the best shipping address for books and materials. Please note -- Hopa Mountain sends books via USPS
Titles:
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Number of books received:
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Number of books remaining (if any):
Number of books unaccounted for (if any):
Please tell us the zip codes of families you distributed books to this cycle:
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Please provide the number of children ages 0-3 you distributed books to:
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Please provide the number of children ages 4-5 you distributed books to:
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Please provide the number of children ages 6-8 you distributed books to:
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Were supporting resources (i.e. title-specific and HealthMakers bookmarks) given to families along with each StoryMakers book?
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Did StoryMakers Team members engage in positive, informative conversations with each parent/caregiver who received a book?
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What kinds of health education resources would you like to have to go along with the books?
If you have books remaining, please explain your plans for their use:
Please indicate the total number of StoryMakers books (with accompanying bookmarks) you would like to request for children during the next 6-month StoryMakers cycle.
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We will try our best to meet the numbers that you request.
What is your estimate for children ages 0-2 served?
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What is your estimate for children ages 3-5 served?
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Please describe your ideas about the events, programs, or other methods through which your Team will meet with parents/caregivers throughout the next cycle.
