Drive less. Save more. OutReach Evaluation

Outreach Evaluation Form

If you are a partner of the Drive Less/Save More Campaign and participated in an outreach project in which you distributed Drive Less/Save More Campaign materials, please complete this outreach evaluation form.

Part of the mandate of this two-year pilot project is to track how the campaign information is being distributed and who is receiving the information. Your assistance will help track this vital information.

Please complete the form as thoroughly and accurately as possible.

*Indicates required information

Contact Information:

*Full Name:

*Organization:

*Full Address:

*Phone Number:

*Fax:

E-Mail:

Outreach Information

*Name of outreach effort:

*Date of outreach effort:

*Type of outreach effort:

*Approximate number of people reached:

*Number of materials distributed that were branded with Drive Less/Save More:

*Number of Drive Less/Save More car decals distributed:

*Number of commitment cards distributed:

*Number of signed pledges:

Other:

Drive Less/Save More information

Is Drive Less/Save More featured on your web site?

	Yes
	No

If yes, how many visits?

Per Day
Per Week
Per Month

Is Drive Less/Save More logo on your agency/organization materials?

	Yes
	No

If yes, please describe materials and number purchased or distributed to date: