Coalition Reporting

(For Local Michigan Asthma Coalition Use Only)

These forms should be used as a tool to track coalition activities, and keep a log of people reached, materials distributed, events attended and progress regarding the modules. An outreach form should be completed for each activity the coalition undertakes. The Electronic Module Reporting forms are due tri-annually as discussed by your asthma consultant.

The forms can be quickly completed by hand or computer and kept as a record of the various coalition activities. The data collected from these forms provides confirmation to MDCH and CDC of program effectiveness. This data can be used to demonstrate the effectiveness and diversity of the asthma coalitions in Michigan and may be a crucial part of our future requests for funding.

Coalition Outreach Forms

• Coalition Outreach - Instructions(Please Read First)
• Coalition Outreach - Online Version (Preferred Method)
• Coalition Outreach - MS Word Version

If you have any questions about these forms, please contact your MDCH asthma consultant.