Covering Kids & Families Back-to-School



Covering Kids & Families Back-to-School

Participation Form

(All organizations that are planning events or conducting Covering Kids & Families Back-to-School outreach are encouraged to return this form.)

* To Covering Kids & Families Grantees: While your online reporting period will include this information, the Covering Kids & Families Communications Team is collecting this information prior to publicize planned activities on the Web site and to distribute to the media.

Contact Name:

Title:

Organization:

Mailing Address:

City: State: ZIP:

Phone: Fax:

E-mail: Media Market:

____ Please include me on your e-mail list so that I can receive updates about plans and resources for the 2006 Covering Kids & Families Back-to-School Campaign.

Please take a moment to complete the following information on your 2006 Covering Kids & Families Back-to-School Campaign efforts.

I plan to (check all that apply):

____ Hold a press conference

____ Issue a press release

____ Submit an opinion-editorial/letter to the editor/drop-in article to the local paper or other publication

____ Pitch b-roll

____ Pitch PSAs

____ Pitch audio bite lines

____ Hold one or more enrollment or outreach events during the back-to-school period

____ Involve elected officials in media/outreach events

____ Explain coverage options for adults

____ Reach out to the community, including local businesses, schools and other organizations

____ Provide the Communications Team with contact information for families that are willing to share their stories with the media

____ Other [please describe]:

____ I give the Covering Kids & Families Communications Team permission to include information about my event in the nationwide Covering Kids & Families Back-to-School Campaign State Activity Report that will be distributed to the media and placed on the Covering Kids & Families Web site.

Please attach a description of activities that you are planning. Examples are provided on the following page.

Briefly describe the activity, including (all that apply):

• Type of event (press conference, media outreach, enrollment event, outreach activity, etc.)

• Date and time

• City and state

• Contact information

• Speakers

• Participating organizations and/or businesses

• Other relevant information

Covering Kids & Families Back-to-School Campaign Activities Examples

|EXAMPLE #1: |

| |

|__X__ Press Conference __X__ Enrollment Event |

| |

|August 2, 9:00 a.m. – 2:00 p.m. |

|Chicago, IL |

|Senator Miguel del Valle will host his 9th Annual Family Health Fair. More than 2,000 people from the community are expected to attend. |

|KidCare enrollment and outreach staff will be on hand and local doctors will provide free health services and screenings. A local Hispanic |

|radio station will do a live feed from the fair between 8:00 and 10:00 a.m. Other speakers will include Robyn Gabel, executive director of |

|the Illinois Maternal & Child Health Coalition; Dr. Virginia Bishop-Townsend, medical director, Jose de Diego Community Academy; and Paula |

|Bermudez, KidCare family spokesperson. The media has been notified and invited to attend. |

| |

|EXAMPLE #2: |

| |

|__X__ Outreach Activity |

| |

|Mid-August |

|Avon Park, FL |

|Representatives from Florida KidCare will be at the community health fair sponsored by the United Methodist Church. Information about |

|low-cost and free health care coverage will be distributed. |

| |

|EXAMPLE #3: |

| |

|__X__ Outreach Activity __X__ Enrollment Event |

| |

|Mid-August |

|Julian, CA |

|Julian Pathways JUSD will work to distribute Healthy Families and Medi-Cal information at K-12 school registration days throughout Julian |

|County. |

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