Take Action: Healthy People, Places, and Practices in Communities Project

PROJECT PLAN DESCRIPTION PAGE

FORM D

ORGANIZATION NAME _________________________________________

1. In the table below, please describe your planned activities.

2. How will you continue this project after the funding period ends?

AGREEMENT TO COMPLETE EVALUATION (REQUIRED)

I agree to participate in an evaluation of this project and complete a report of how funds were spent by June 15, 2008.

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Signature Date

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Printed Name