Minnesota Department of Health
Tobacco-Free Communities Grant
Monthly Progress Report
Grantee Name
Project Title
Reporting Period


Indicate Month and Year
Reports are due one month
after the end of the
reporting period.
Please submit your updated Tobacco Policy Evaluation Tracker with the April, July, and October monthly
progress reports.
Quarterly Reporting Period
February 1 – April 30, 2015
May 1 – July 31, 2015
August 1 – October 31, 2015
Due Date
May 31, 2015
August 31, 2015
November 30, 2015
Describe discussion items
for your monthly check in
call.
Describe policies passed
during this reporting
period.


Include policy type.
Send copies of policies
passed using TFC funding
during the current reporting
period to your community
specialist and the
appropriate TA provider.
List Trainings Attended.
The purpose of the monthly progress reports is to provide ongoing updates on significant activities and outreach
efforts as outlined in your work plan. These monthly progress reports should be a summary of what you did this
month. Feel free to leave sections blank if you did not work on certain types of activities during a given month.
Please add additional strategies, objectives, and/or implementation activities as needed.
For activities and outreach efforts not directly tied to a specific strategy, or those crossing over multiple
strategies, please provide summaries in the “Other Work” section.
Provide a brief success story in the “Success Story” section. We want to hear about how your work has positively
affected your community, and welcome stories that illustrate the meaning behind your efforts. You do not need
to provide a story every month, but we hope to use these stories to further recognize your efforts in improving
the health of your community.
Updated May 2015
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Our goal is to communicate your successes and good work to stakeholders and decision makers, as well as spark
collaboration among grantees. Stories may be published to MDH’s website, shared through newsletters and
social media, and included in reports to the legislature and federal agencies. We will work with grantees to
finalize the details of all stories, and grantees are welcome to share their stories through their own networks.
Updated May 2015
2
Activity and Outreach Tracker
List your activities below. Start by choosing your activity type and focus from the dropdown menus.
Definitions for Activity Type Options
Coalition participation – An activity that involves a meeting or discussion with a coalition member or members that is aimed at advancing TFC goals/objectives.
Community education – An activity aimed at increasing awareness and/or knowledge of tobacco prevention and control issues (e.g., community health fair presentation, conducting a webinar).
Data collection – An activity with the main purpose of collecting data using an assessment, survey, questionnaire etc.
Earned or paid media – An activity in which publicity for TFC work is gained through promotional efforts or advertising (e.g., newspaper article, billboard, advertisement)
Social media – An activity in which grantees interact with the community via social networking sites (e.g., Facebook, Twitter).
Stakeholder meetings – An activity involving stakeholders that is aimed at introducing stakeholders, educating them about TFC goals/objectives, and/or promoting PSE changes.
Example
Activity Type
Focus
Name of Activity
Date
Start
community
education
community education
coalition
participation
social media
coalition/partnerships
community education
Dangers of
Secondhand Smoke
presentation
Monthly coalition
meeting
Facebook posts
Purpose/Goal
Focus
Choose an item.
Choose an item.
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Updated May 2015
Name of Activity
Number of
Attendees
Number of Youth or
Volunteers Trained
Click here to
enter a date.
4/30/2015
Highlight dangers of secondhand smoke
1st-5th graders
75
0
Click here to
enter a date.
4/1/2015
4/15/2015
Discuss progress, challenges, and next steps with
coalition members
Promote community awareness of upcoming cessation
events
Coalition members
12
0
Facebook
friends/followers
200
0
4/30/2015
Date
Activity Type
Choose an item.
Type of Attendees
End
Start
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End
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Purpose/Goal
Type of
Attendees
Number of
Attendees
Comments
Posted 4 messages to
Facebook; received a
total of 150 likes
Number of Youth
Volunteers Trained
Comments
3
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Updated May 2015
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4
Strategy
(e.g., Point-of-Sale, SF Housing)
Annual Objective(s)
Implementation Activity 1

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 2

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 3

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 4

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Updated May 2015
5
Strategy
(e.g., Point-of-Sale, SF Housing)
Annual Objective(s)
Implementation Activity 1

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 2

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 3

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Implementation Activity 4

Enter a key activity for the
above strategy.
Progress
Challenges or barriers
Adjustments being made to
address challenges or
barriers
Success in reaching program
milestones
Updated May 2015
6
Other Work
Please use this space to describe or
list other related work conducted
this month, highlights or
information to share.
Success Story
Please use this space to provide a
brief success story that describes
how an individual or individuals
have been positively affected by
your work.
Stories could include:

What happened? Was it
expected or unexpected?

What has changed due to your
efforts?

How will this make a
difference (for the person or
community)?

A picture or positive quote
from someone impacted by
these efforts*
Visit TFC Grantee Resources online
for a sample framework for
developing your success story.
*
Please ensure permission has been obtained by subjects photographed to share the picture and/or to provide the quote
Updated May 2015
7