Form Event Description Event Description Event Description Form

Event Code ________________

TTC Event Description Form

Please complete this form for each event implemented or sponsored by your TTC.

Date: ___________________ Location: ________________ TTC: ____________________

Event Title: _____________ ______________ Event Code No.: ___________________

Total # of participants: ________

# of participants consenting to follow-up: _________ Total # of Follow-up surveys sent: _____

Enter N/A for “Not applicable” if the event is less than three hours.

How many contact hours is this event? __________

For international TTCs ONLY:

Is this a PEPFAR qualifying event? ____YES ____NO

1/15/21 Page 0 of 3