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Full Name:
Title/Position:
Organization:
Mailing Address:
Phone:
E-mail Address:

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1.  Describe Your Organization
County	City	State
Neighborhood	School	Church
Media	Service Organization	Business
Individual	Other

2.  Who is Your Target Audience?
Employees	Customers	Students
Cities	Residents (Apts., Mobile Homes, etc.)
Media	Service Organization	Business
Individual	Other

3.  How many people are in your target audience?	Unknown
4.  How many people in your target audience receive ESP?	Unknown

5.  Briefly describe your participation in this year's ESP campaign.
Provide copies of:	Focus Sheets	Calendars
All Employees
Students/Staff
Each Department
Members
Other

Post:
Calendar	Focus Sheets
Bulletin	Poster
Articles in organization newsletter	Involve local media
ESP web page	Organization web page
Please elaborate:

6.  On a scale of 1 to 4, please rate the following: (1=poor, 2=fair, 3=good, 4= excellent)
Monthly Focus Sheets	1     2     3     4
Calendar	1     2     3     4
Poster	1     2     3     4
Bulletin	1     2     3     4
Activity Book for Kids	1     2     3     4
Your target's group's response to the campaign	1     2     3     4

7.  What do you like most and least about the campaign?

8.  Please give any additional ideas or suggestions that can be used in planning future ESP campaigns.
9.  Are you interested in participating in future ESP campaigns?	Yes       No
10.  Are you interested in being a sponsor of ESP to assist with printing, etc.?	Yes       No