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

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

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

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

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

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

7. 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)

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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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?)

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