Collaboration Contract Event

							                                                                                     Appendix A
                                                              Instructions for Completing Special Initiatives Forms




Annual Initiatives: Using the Initiative Name column, enter the name of the initiatives/activites in which your AIC participates every year for your community. In the Description
column of the form, provide brief general description of the project and the role of your AIC. In the appropriate colums indicated for Start Date and End Date of each initiative. In
the Collaboration Partners column, provide the names of the agencies, excluding the AIC, that are invovled in the initative/activity.




One-Time Only Initiatives: Because these occur with very little notice, for the purpose of this inventory, use this form to report activity conducted in your region that was beyond
the scope of regular I&R but will not or is not expected to be done annually or become an on-going commitment. (i.e. your center is asked to provide scheduling of
appointments for a multi-day and multi-location immunization clinic.) Using the Initiative Name column, enter the name of the initiatives/activites in which your AIC conducted. In
the Description column of the form, provide brief general description of the project and the role of your AIC. In the appropriate colums indicate the Start Date and End Date of
each initiative. In the Collaboration Partners column, provide the names of the agencies, excluding the AIC, that are invovled in the initative/activity.




On-going Commitments: Activities/Event(s) that are On-Going Commitments in your region that involves 2-1-1. (i.e. every day from 4:55 PM to 8:05 AM all 3-1-1 calls from
Hometown City rolls to the XX Area Information Center.) Using the Initiative Name column, enter the name of the initiatives/activites in which your AIC conducted. In the
Decription column of the form, provide a brief, general decription of the project and the role of your AIC. In the appropriate colums indicate the Start Date and End Date of each
initiative. In the Collaboration Partners column, provide the names of the agencies, excluding the AIC, that are invovled in the initative/activity.



Data Timeframe: Populate each form with data for initiaves your agency will (or plans to participate in) conduct in calendar year 2011.


Contact: Provide the name of the person at your agency resposible for organizing or ensuring your agency's participation in the event.
                                   Appendix A
                    Regional Annual Special Initiatives FY 2011



Initiative Name   Description                            Start Date   End Date   Collaboration Partners   Contact
                               Appendix A
               Regional One Time Special Initiatives FY 2011



Project Name   Description                           Start Date   End Date   Collaboration Partners   Contact
                                Appendix A
                 Regional Ongoing Special Initiatives FY 2011



Project Name   Description                           Start Date   End Date   Collaboration Partners   Contact