| County: |
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| Area served (i.e., neighborhood, school, city-wide, county-wide, state-wide, etc...): |
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| Intervention/project Name: |
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| Partners (i.e., city/county/state agencies, non-profits, citizen groups, healthcare providers and organizations, worksites, business partners, schools/childcare, etc...): |
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| Category of intervention/project: |
Nutrition
Breastfeeding
Physical Activity
Safe Routes to School
Other (e.g., reducing television/screen time, promoting caloric balance, portion distortion, decreasing sweetened beverage consumption)
Please Specify:
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| Population(s) served: |
Young children (newborn - 5 yrs)
School-aged children (K-8)
Adolescents (grades 9-12)
Adults (ages 18 - 65 yrs)
Older adults (ages 65+yrs)
All ethnicities
Native Americans
Other ethnicity (please specify):
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| Setting: |
Community
Workplace
Healthcare
Childcare
Schools
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Purpose -
Provide a brief summary of the overarching purpose or primary goal of intervention/project:
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| Description of intervention/project: |
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Evaluation Plan -
Describe how you will determine if your initiative/project is a success or is progressing toward accomplishing your goals (i.e., surverys, focus groups, stakeholder interviews, data collection, etc...):
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Status -
State whether this initiative/project is ongoing, periodic, or a one-time event. Be as specific as you can (i.e., this program is a pilot project that will take place during the 2006-2007 school-year)
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Completed
Ongoing. Estimated completion date, if known:
Periodic. Details:
One-time event. Details:
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| Submitted by: |
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| Email address of contact person: |
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Additional contact information -
If you would like to share your initiative/program with other Montana communities, please provide a contact name (if different from above), address, and phone number:
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