priority.htm


Instructions: If you have an event number, you will only need to fill out the items in blue and red. If you do not have an event number, you will have to fill out ALL items in blue and black.
Name:	First	Last
Priority One Member Number:
I attended Priority One Event Number:
On Date : mm/dd/yy


If you do not have a Priority One event number, please fill out the portion below:
I am reporting a Priority One Activity on : mm/dd/yy
In ZIP Code:
Approximately adults and young persons participated in this activity.
What one of the following verbs best describes the action you are reporting? Attended meeting/event Planned Spoke Watched video/film Hosted Wrote Listened broadcast/tape Sponsored Presented Mentored Counseled
Select a SINGLE Priority One Activity that you are reporting from the list below. (PLEASE SUBMIT A SEPARATE FORM FOR EACH DIFFERENT ACTIVITY.)
Meetings Workshop Conference Committee or Task Force Broadcast/Tele-conference	Direct Services Mentoring Counseling Discussion Program Evaluation Public Policy Advocacy	Letter or Publication Article Advertisement Acknowledgement
Which is the primary Program Objective of Priority One that was addressed in the activity you are reporting? (Select the one Objective that best describes your participation.)
Increase the ability of parents and other adults to discourage drug use to our youth. Increase the capacity for youth to influence other youth not to use drugs and to intervene in situations in which drug use is present. Enhance the community's vigorous anti-drug media and public information campaigns. Support and enhance school-based prevention programs. Promote and support community-based prevention and intervention programs. Disseminate information on the negative consequences of drug legalization for youth