Database Submission Information

Programs submitted to the database must be community-based and focus on eye health prevention and promotion. NEI staff will review submissions and reserves the right to edit submissions. Editing is primarily for clarity to ensure that the entry clearly describes the program’s activities and impact. Email notices will be sent if submission has been accepted or not.

To submit your program to the database, complete the following information. If you need help, please email hvcamail@shs.net.

Organization Name:


Organization Type:
-Select an Organization Type- Aging CDC State-based Diabetes Program Faith-based School/University State/Local Not-for-Profit Civic Organization Lions Club Federal Government Agencies Other State Government Agencies Local Government Agencies American Indian/Alaskan Native

Project Title:

City:

State:

-Select a State- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam 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 Northern Mariana Islands Ohio Oklahoma Oregon Other Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Project Contact Person:

Phone Number:	Fax Number:

Contact's E-mail:


Organization Website:


Are you willing to be contacted by other groups
interested in replicating your efforts?
Yes No

Collaborators/Partners on Project:


Funding Source:
-Select a Funding Source- NEI Community Awards Program Private Foundation Corporate Funding Professional Organization State Funding Federal Funding Other

Topic Area:
-Select a Healthy Vision Category- Examinations and Prevention Eye Diseases Injury and Safety Vision Rehabilitation

Eye Disease Category:
-Select a Eye Disease Category- Diabetic Retinopathy Glaucoma Cataract Pediatric Eye Conditions Age-related Macular Degeneration Other

Target Audience:
Children and Adolescents
Older Adults
African Americans
Hispanics/Latinos
Asians/Pacific Islanders
American Indians/Alaska Natives
Rural
Urban
Caucasian
Caribbean

Training and Technical Assistance (patient, provider, and/or caregiver)
Media (TV and radio PSAs, print news releases, Web-based materials)
Message Development
Materials development and Dissemination
Volunteer-based
Case Management and Follow-up
Outreach Strategies (health fairs, workshops, community presentations, vision screenings)
Other

Project Abstract: SpellCheck
Currently at 0 character(s).


Describe your approach to addressing vision health problems in your community. SpellCheck
Currently at 0 character(s).


What have been the biggest barriers and/or challenges you have encountered? How did you address them? SpellCheck
Currently at 0 character(s).


Describe why your project is successful. SpellCheck Currently at 0 character(s).


How many people did your project reach? List some of the more effective ways in reaching them. SpellCheck
Currently at 0 character(s).


How have you measured the effectiveness of your project? SpellCheck
Currently at 0 character(s).


Describe the replicable components of your project. SpellCheck
Currently at 0 character(s).

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