2013 Community
Impact Project

Thank you for your interest in the 2013 LIVESTRONG Community Impact Project. The Community Impact Project serves as a mechanism to minimize costs for program development and evaluation by replicating evidence-based programs.

LIVESTRONG receives many requests from organizations that are interested in replicating their programs on a national level. To streamline our review process, please answer the following questions regarding your program. The following questions and your responses allow us to select programs to formally apply for replication through the Community Impact Project. Selections will be made based on need and program type. Should you have any questions throughout this process please email Community@LIVESTRONG.org.

Personal Information

First Name *   Last Name *   Organization *   Program being submitted for replication *   Address Line 1 *   Address Line 2 City *   State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code *  

Phone

(XXX) *  

XXX *  

XXXX *  

Email Address *   

Organization/Program Information

Does your program serve only people affected by cancer? No Yes Does your organization have nonprofit status (501c3 or other) from the United States Internal Revenue Service? No Yes Has your program been evaluated for its effectiveness in any way? No Yes Has your program been implemented in a second location other than where it was initially created? No Yes Is your program currently ready for replication in 20–35 new communities across the United States? No Yes Has your program been running for more than two years (24 months in total)? No Yes Does your program currently offer online training for its implementation? No Yes If not, could one be created that would still allow the program to run effectively? No Yes