Outreach Reporting Form Name of Submitter Email of Submitter Name of Outreach Event Date of Outreach Event Host Organization Location of Outreach (Name and Address) Outreach CountyNationalStatewideRegionalOut of StateAccomackAlbemarleAlexandriaAlleghanyAmeliaAmherstAppomattoxArlingtonAugustaBathBedfordBlandBotetourtBristolBrunswickBuchananBuckinghamBuena VistaCampbellCarolineCarrollCharles CityCharlotteCharlottesvilleChesapeakeChesterfieldClarkeColonial HeightsCovingtonCraigCulpeperCumberlandDanvilleDickensonDinwiddieEmporiaEssexFairfaxFairfax CityFalls ChurchFauquierFloydFluvannaFranklin CountyFranklin-CityFrederickFredericksburgGalaxGilesGloucesterGoochlandGraysonGreeneGreensvilleHalifaxHamptonHanoverHarrisonburgHenricoHenryHighlandHopewellIsle Of WightJames CityKing And QueenKing GeorgeKing WilliamLancasterLeeLexingtonLoudounLouisaLunenburgLynchburgMadisonManassasManassas ParkMartinsvilleMathewsMecklenburgMiddlesexMontgomeryNelsonNew KentNewport NewsNorfolkNorthamptonNorthumberlandNortonNottowayOrangePagePatrickPetersburgPittsylvaniaPoquosonPortsmouthPowhatanPrince EdwardPrince GeorgePrince WilliamPulaskiRadfordRappahannockRichmond CountyRichmond-CityRoanoke CountyRoanoke-CityRockbridgeRockinghamRussellSalemScottShenandoahSmythSouthamptonSpotsylvaniaStaffordStauntonSuffolkSurrySussexTazewellVirginia BeachWarrenWashingtonWaynesboroWestmorelandWilliamsburgWinchesterWiseWytheYorkWas there a demonstration of equipment Yes No Out of State - DefinedAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificRegional - DefinedCentral VirginiaEastern ShoreGreater FredericksburgGreater RichmondHampton RoadsI-81/I-77 CrossroadsLynchburg RegionMiddle PeninsulaNew River ValleyNorthern NeckNorthern Shenandoah ValleyNorthern VirginiaRoanoke RegionShenandoah ValleySouth Central VirginiaSouthern VirginiaSouthwest VirginiaVirginia's Gateway RegionStaff, Interns, or Ambassadors PresentPrimary Outreach Contact (Name and Email/Phone Number)Purpose of Outreach Advocacy Athlete Recruitment Awareness Disability Etiquette Training Donor Cultivation Education Intern Recruitment Member Outreach Volunteer Recruitment Other Purpose - Other Audience General Community OT students PT students K-12 students Parents/Caregivers Potential Athletes Potential Donors Staff Teachers Clinicians Community Partners Other Current Athlete Audience - Other Type of Engagement1-on-1 Athlete/Potential AthleteAdaptive Sports ExperienceCommunity PresentationConference PresentationCorporate PresentationFlyer DeliveryTabling/Resource FairTrainingUniversity/School PresentationMethod of OutreachIn-PersonVirtualPhoneHybridNumber of Attendees (Total Attendance) Number of Impressions (Individuals Reached) Number of Hours Number of Leads Created (if applicable) Lead NamesOutreach Strategic Goals Connect or refer people Provide direct opportunities Inform potential referral sources Train or empower others Recruit individuals to volunteer Educate students and professionals Dispel stigmas and advocate for inclusion Community awareness Other Other - Strategic Goals Did this raise awareness of our work in a meaningful way?Definitely NotNot LikelyNeutralVery LikelyDefinitelyPlease explain:Did this event fulfill any grant deliverables? Underserved Communities People with Spinal Cord Injuries/Traumatic Brain Injuries (SCI/TBI) Please explain:Was there meaningful interest in our programs/services?NoneLowModerateHighMembershipVolunteer OpportunitiesDonors/SponsorsHow would you rate the event's logistics and fit for our goals?PoorFairGoodExcellentVenue AccessibilityBooth/Table LocationAttendanceAudience AlignmentCommunicationWhat were the key outcomes or benefits of attending this event?Were there any challenges or things that did not go well?Should we participate in this event in the future?YESNOMaybe (Follow Up with Organizers)Recommendations for next time (e.g. materials to bring, messaging to adjust, who should attend):Notes:Please share any notes or details about event. If slides were used, add link here: Δ
