Community Benefit

Name

First Last

Email

Sponsoring Department

Name of Program/Event*

Location of Program/Event:

Program Date

Program Description

Who, What, When, Where, Why? - What was done? Who was served?

What is the impact on health?

What was the Community Health Need being addressed and how was the need demonstrated?

How many people attended?

What is the target population?

Lead Person(s)*

Include all persons who were leaders or contact persons in SH's participation in this program as well as how much time they dedicated toward the entire project.

Name	Hours	Description of Job

Additional Staff

Include any additional SH staff that participated in this program as well as how much time they dedicated toward the entire project.

Name	Hours	Description of Job

Program Costs

Include all employee labor cost (time dedicated x current hourly wage), supplies, travel & other expenses. Click on the Plus sign at the end of the row to add more.

Description	Cost