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2. Contracting Organization Name*
   This MUST be the organization the County has a contract with
3. Implementation Organization Name*
5. Contracting Organization Contact Name *
   Full name of the primary contact at the contracting organization in case we have any questions
6. Implementation Organization Contact Name*
   Full name of the primary contact at the implementation organization
8. Contracting Organization Contact email*
   Email address for the contracting organization's contact
9. Implementation Organization Contact Email*
11. Contact Phone Number*
    Phone number for the contact
12. Implementation Organization Contact Phone Number*
14. Were you assigned a Computer for QAC/QAK?*

    1. Yes
    2. No
15. If you were assigned a computer, have you returned it to the County?

    1. Yes
    2. No
    3. N/A
17. Have you submitted all your event reports? *

    1. Yes
    2. No

    We need ALL reports complete prior to issuing a final check. If you are unsure, please contact [email protected]
18. Event Report Submission
    Download Report Template here

    If you need to fill out your event reports, please use the template provided below. Please submit report to [email protected]
20. What elements below were helpful to you? *

    1. Regional Training
    2. Regional Workshops
    3. Outreach Toolkit
    4. Social Media
    5. Computer Loans
    6. Newsletter Article Templates
    7. Non-English Language Material
    8. Grants for Community Based Organizations
    9. Printed Material and Swag for Grantees
    10. Website (cococensus.org)
21. Please elaborate or let us know anything else that was helpful in the Census Outreach /AssistanceProcess*
23. What elements need work? *

    1. Regional Trainings
    2. Regional Workshops
    3. Outreach Toolkit
    4. Social Media
    5. Computer Loans
    6. Newsletter Article Templates
    7. Non-English Language Materials
    8. Grants for Community Based Organizations
    9. Printed Material and Swag for Grantees
    10. Website (cococensus.org)
24. Please elaborate or let us know about anything else that needs improvement*
26. What were some highlights for your organization
    We would love to hear about and share some highlights from your Census Outreach and Assistance experience.
28. Do you have photos or materials you would like to share

    1. Yes
    2. No
29. Describe the photos or other materials you would be willing to share?
    We will contact you if you have some photos or other material that you would like to share with us.
31. Any other thoughts or comments to share?
    Is there anything else that we should know about when evaluating our efforts or planning for Census 2030?
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field