Parent Ambassadors Data Form
Parent Infinite ID
Parent Email
Event/Service Details
Event Name (or Support/Services Provided to)
Event/Service Type
Please select...
Workshop
Outreach
Training
One-On-One
Fair/Community Event
Meeting
Event/Service Date
Event/Service Topic
Please select...
Academic Support
Behavior
Cal Fresh
Cal Works
Domestic Violence
Employment
Food Bank/Clothing
Health Insurance
Housing
Leadership Development
Legal
Medi Cal
Mental Health
Parenting
School/Education Activity
Substance Abuse
Transportation
Wellness
Total People Served
How many received Snack or Food
Duration Hours
Minutes
Attendee Health Insurance Information
# People with Health Insurance
# People without Health Insurance
# of People Unsure of Health Insurance
Attendee Ethnicity Information
# of African America or Black
# of Asian
# of Caucasian or White
# of American Indian or Alaskan Native
# of Latino/Hispanic
# of Native Hawaiian or Pacific Islander
Attendee Gender Information
How many Males
How many Female
How Many Transgender
Attendee Age Group Information
Number of Attendees ages 0 to 4
Number of Attendees ages 5 to 15
Number of attendees ages 16 to 24
Number of attendees ages 25 to 65
Number of attendees over 65
Contact Information