Success Story Form (screenshots)

ATSDR Success Story Form
Project or Site Name *

Is activity related to COVID‐19?
﴾If yes, check box﴿

Attachments

Link

Please include photos!

Type the Web address:

Text to display:

Add a relevant link to the site or project, if applicable.

APPLETREE? *

Choose Safe Places Program

Yes

Please select a value...

No
Is the success story from an APPLETREE partner?

Is this a success story for the Choose Safe Places for Early Care and Education
(CSPECE) program?

City *

State *
Please select a value...

POC *

List who should be contacted for further information about the success story.

Brief Summary *
In 1‐3 sentences, give a brief summary of the success story.

Background
In 140‐250 words, describe relevant background of site or project. Include dates and who was involved.

Intervention
In 140‐250 words, describe the solution, intervention, or action that was taken.

Accomplishments
In 140‐250 words, describe the impacts, outcomes, and results of the actions that were taken.

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