Data Collection and Reporting Forms
Informed Consent form
The informed consent document is our commitment to our participants that we will keep their information in a confidential manner. The process and forms are accessed here.
Photograph Consent Form
The photograph consent document is the document required by Cornell Legal, specific to FNEC programming, for participants for whom we take photographs. Counties have, in the past, generated their own release forms for this purpose. It is important that any FNEC program participant for who a picture is taken, or will be taken, complete this form. This form is included within the Adult Entry form or can be accessed here.
Adult Entry, In-between and Exit forms
The enrollment, in-between and exit forms capture and allow for the updating of demographic data on our adult participants. The forms are accessed here.
Behavior Checklist Question forms
Behavior checklist questions have been developed to assess the impact of our programs based on the curricula being used. Care should be taken to use the questions set that is reflective of the curriculum being used with the participant. These forms are accessed here.
24-Hour Diet Recall form
The 24-hour diet recall allows participants to assess the changes they have made in their diet as a result of participating in nutrition education programs. These forms are accessed here.
4-H Youth Development form
The 4-H Youth Development form tracks the education efforts of staff with youth audiences. Counties engaging in youth programming must adhere to the guidelines as defined in the Policy and Procedure Manual - section 700. The 4-H Youth Development form is accessed here.
Volunteer Registration form
Capturing the efforts of volunteers within your nutrition education program demonstrate the extent to which members of the community support your programming. The Volunteer Registration form is accessed here.
Marketing and Recruiting Activity form
Not all of your efforts with adults or youth are entered into the County Reporting System (CRS5). The provided form provides one way in which these efforts can be tracked and aggregated at the county level. The Marketing and Recruiting Activity form is accessed here.
Success Story/Impact Report form
Capturing the qualitative impact of our program provides a breadth to our reporting that the County Reporting System (CRS5) is unable to capture. The Success Story templates are available. There are versions of the template that would contain a picture and one that would not. The EFNEP template with the picture is accessed here and the EFNEP template without the picture accessed here. The Eat Smart New York template with the picture is accessed here and the Eat Smart New York template without the picture accessed here. The success story focuses on the behavior change of one participant or group of participants. This is a narrative document which often includes a picture of the participant or the change being highlighted. As these are templates, it will be important to update any of the information highlighted in yellow, such that the correct program year and association will be represented. Submitted success stories will be posted to the FNEC web site.
There are two Impact Report forms, one for EFNEP and one for SNAP-Ed. The impact report summarizes the outcomes from an individual or group, providing an overview of the lessons delivered, curriculum used, and changes made.
FNEC Lesson Plan and Progression Record form
The lesson plan and progression record document details the efforts that are done with the participants reached and their responses to those efforts. Both adults and youth reached through FNEC programming should have lesson plan and progression record documentation on every lesson/session offered. The FNEC Lesson Plan and Progression Record form is accessed here.
EFNEP and ESNY! (SNAP-Ed) Quarterly and Year-End Report Forms
The above link provides access to the Quarterly and Year-End Reporting forms for EFNEP and ESNY!(SNAP-Ed).
