The 2007-08 innovative outreach practice submission application is brief, comprised of one question regarding the innovative efforts your organization has demonstrated to better serve farmworkers. Please complete the form below to submit your practice(s). Organizations may submit up to three innovative outreach practices. You may submit this application on-line, by fax, or via email. If you have any questions or would like to receive a copy of the application by fax or email, please e-mail us at kristie@farmworkerhealth.org.

All innovative outreach practice submissions by migrant and community health centers will be considered for the Sister Cecilia B. Abhold Award.

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Innovative Outreach Practice Submission Application

Please answer all questions below.

*Name:

*Title:

*Organization:

*Organization Type:
330 (g) non-330(g) don't know

Address:

*City:

*State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

*Zip:

*Phone:

*Email:

*Describe one of your outreach program's best or most innovative outreach practices and explain why it is innovative. What is the practice? What makes it innovative? Does it utilize health center or community resources in a particularly new or effective way? Does it address a new or emerging issue among farmworkers? Does it improve on a previous practice or take a new approach to providing health outreach services to farmworkers? Please try to be as specific as possible in your description and attach additional pages if necessary. (500 word limit)

I consent to FHSI using the information contained in my Sister Cecilia B. Abhold Award Nomination to be printed in FHSI's Innovative Outreach Practices Report next to my organization name.