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  Healthy Start, Grow Smart Quarterly Report

Complete the following information about your organization.

Reporting Period January through March
   
  April through June
July through September
October through December
FCM Name
Street Address
City
State
ZIP
Name of Person Completing
Title
Phone
E-mail Address
Please complete the following questions:
 
1. How many 13-pamphlet packets have you distributed during this quarter?
2. Are parents generally receptive to the information presented in the Healthy Start, Grow Smart brochures? Yes No
3. Based on your experience, are parents using the information in the brochures? Yes No
4. If no, please explain why.  
 
5. Is there anything you’d like to change? Yes No
6. If yes, please explain.        
 
7. Do FCM staff review the information in the pamphlets with parents? Yes No
8. Did you have a sufficient supply of the 13-pamphlet packets? Yes No
9. Comments/Suggestions        
         
10. Is your FCM agency willing to participate in this program next year, if offered? Yes No
11. If no or unsure, please explain.        
         
12. Answer this question only in the July-September quarterly report. Please estimate the number of packets you will need for next year.    
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