*Action Group:

Action Group Advisor:

* Action Group Rep:

* Action Group Rep's Email:

Reporting Month:

Number of meetings since last report:

Focus of Meetings: (check all that apply)

Briefly describe your meeting:

Name of Project/Activity:

Type of Activity:

Activity Focused On:

Date Active Planning Started:

Date Implementation Started:

Date Implementation Ended:

Brief description (include main features, the role of your Action Group, reasons for doing the
activity, etc...)

How many members were involved in planning and implementation?

Number of persons affected:

Do you think your activity was a success? Please explain why.

What, if anything, could have been done to improve the activity?

Would you recommend this activity to other Action Groups?