MONTHLY REPORT

MONTHLY REPORT

Due By 5th Day of Each Month to reflect the activities of the previous month - Please submit separate reports for Temple, Court, or Desert Activities. Complete all required fields then scroll to the bottom of the report and click the Submit Button. Reports MUST be submitted ON-LINE. We cannot accept hard copies.
Fiscal Year*
Select Fiscal Year For Report
Report Month*
Select Desert*
Report is For*

TempleCourtDesert
When selecting DESERT, please report only on activities that were entirely a function of the Desert. If the event was in conjunction with a Temple or Court, please report as a TEMPLE or COURT event. If your Temple or Court is not listed, please email nchi@aeaonms.org.

PLEASE DO NOT SUBMIT DESERT REPORTS FOR ZERO ACTIVITY !!
Select TEMPLE*
Select COURT*
Is This A Correction ?*

Correction ReportRegular Report

MONTHLY ACTIVITIES: Please provide information on your activities for the month. Enter the MONTHLY Totals for activities whether any funds are generated or not. Complete Each section for Each Category, Enter number ZERO (0) if there was No Activity and PLEASE do NOT use TEXT or SYMBOLS.*

	Number Held	# People Impacted
Fundraisers
Health Fairs
Outreach Events
Planning Meetings
Community Health Walks
Other Activities

Please provide details on other activities
If you reported anything in OTHER Activities, please use the section above to describe briefly what the activity entailed
Report Submitted By*

First NameLast Name
Your Email Address ?*

Confirmation Email
Thank you for submitting your monthly report documenting your National Community Health Initiative (NCHI) activities.
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