Mobilizer/Contact Name and Title Email Phone Number Coalition Name Mobilizer/Contact Name and Title Email Phone Number

Coalition Information Include year the coalition was formed and any pertinent historical information

Coalition Information Provide brief descriptions of workgroup/committee responsibilities/duties.

Coalition Information Provide a coalition organization chart (if available) or explain how the coalition is organized.

Coalition Service Area What is/are the location(s) served; identify if it serves rural, suburban, or rural areas.

Coalition Service Area List data and information to tell the story of the service area.

Community Sector Engagement Community Sector most actively engaged An example of their contributions (this section should be 2-3 slides and should highlight 2-3 sectors)

Community Sector Engagement Community Sector most actively engaged An example of their contributions

Community Sector Engagement Community Sector most actively engaged An example of their contributions

Community Issues/Priorities This section should be 2-5 slides. List and describe the targeted behaviors and issues the coalition is addressing; of these describe which are the priorities Provide and overview of the data and resource analysis that the coalition uses to determine priorities For each priority, provide 2-3 risk factors, and/or other root causes For each RPF or other root cause, provide a statement of why the coalition believes the issue is occurring

Community Issues/Priorities This section should be 2-5 slides. List and describe the targeted behaviors and issues the coalition is addressing; of these describe which are the priorities Provide and overview of the data and resource analysis that the coalition uses to determine priorities For each priority, provide 2-3 risk factors, and/or other root causes For each RPF or other root cause, provide a statement of why the coalition believes the issue is occurring

Community Issues/Priorities This section should be 2-5 slides. List and describe the targeted behaviors and issues the coalition is addressing; of these describe which are the priorities Provide and overview of the data and resource analysis that the coalition uses to determine priorities For each priority, provide 2-3 risk factors, and/or other root causes For each RPF or other root cause, provide a statement of why the coalition believes the issue is occurring

Community Action Planning This section should be 3-5 slides. Briefly describe the major points found in the community action plan; if no plan is in place, describe how & when the coalition is expected to get their plan in place List measurable outcome(s) for each priority identified in Community Priorities section; if no community action plan is in place, list any measurable process outcomes that the coalition has achieved to date and any other measurable outcomes the coalition is considering List programs, practices, and/or environmental approaches that are in place to address priority  Briefly describe how the coalition plans to sustain both mobilization/coordination efforts and strategy implementation  Describe 4-5 action items the coalition will be focusing on in the coming year

Community Action Planning This section should be 3-5 slides. Briefly describe the major points found in the community action plan; if no plan is in place, describe how & when the coalition is expected to get their plan in place List measurable outcome(s) for each priority identified in Community Priorities section; if no community action plan is in place, list any measurable process outcomes that the coalition has achieved to date and any other measurable outcomes the coalition is considering List programs, practices, and/or environmental approaches that are in place to address priority  Briefly describe how the coalition plans to sustain both mobilization/coordination efforts and strategy implementation  Describe 4-5 action items the coalition will be focusing on in the coming year

Community Action Planning This section should be 3-5 slides. Briefly describe the major points found in the community action plan; if no plan is in place, describe how & when the coalition is expected to get their plan in place List measurable outcome(s) for each priority identified in Community Priorities section; if no community action plan is in place, list any measurable process outcomes that the coalition has achieved to date and any other measurable outcomes the coalition is considering List programs, practices, and/or environmental approaches that are in place to address priority  Briefly describe how the coalition plans to sustain both mobilization/coordination efforts and strategy implementation  Describe 4-5 action items the coalition will be focusing on in the coming year

Celebrating Coalition Success This section will be 2-4 slides Use longitudinal PAYS data, other local data, and process information to provide the data that demonstrate the coalition’s success in impacting the identified priorities and community issues

Celebrating Coalition Success Provide 3-5 specific benefits that your coalition brings to your community (What would the community lose if your coalition no longer existed?)

Celebrating Coalition Success As applicable, include information about how the coalition has overcome any challenges/limitations to their work