Data Forms – Geos Institute

Navigator Support Activities

State

Community

Which community goal is this task related to?

Short Title

Brief 1-paragraph description

Priority for Navigator

Type of assistance

If other, please describe

Is the assistance focused on CDRZ designated areas?

Which CDRZ areas is this assistance focused on?

– Fill Out Other Fields –

Is there a deadline for this assistance to be completed?

Deadline

Status of the assistance

Regional Support Team

Did you access the Regional Support Team for help with this task?

If yes, please explain what you sought from the Regional Support Team members

Was the support helpful/successful?

If no, where else did you look to get the help you needed?

Outputs (Technical Assistance)

Type of technical assistance provided

If other, please describe

Outputs (Grant Writing/Coordination/Support)

Grant Name

Dollar value

Submitted?

Was the grant awarded/received?

Outputs (Project Finance)

Finance type

If other, please describe

Funding source

Dollar value

Outputs (Capacity Building)

Capacity Type

If other, please describe

Duration of assistance

Cost to the community

Outputs (Training)

Training type

Number of participants

If other, please describe

Brief summary of the focus of the training

Outputs (Engagement)

Focal populations for engagement

All community members

Racial minority community

Ethnic minority community

Tribal community

Socially vulnerable community

Other (please describe below)

If other, please describe

Type of engagement efforts

In-person meetings

Virtual meetings

Direct reach out to local leaders

Attendance at community events

Collaborative activities

Other (please describe)

If other, please describe

Results of engagement efforts

Notes/Comments

Outputs (Networking/Coordination)

What groups were part of this effort?

How did this effort help the community?

Outputs (BRIC Application Support)

Did the community successfully submit the application?

If yes, was the project selected to move forward at the state level?

Outputs (Other Support)

Please describe the tangible outputs of this assistance

Please describe the resilience objectives achieved or impacted due to the outcomes above

Community Overview

State

Community Name

Community Type

If other, describe the community type

What is your pre-existing connection or relationship to this community, before you began work as a Navigator?

Please select the nature of your pre-existing relationship with this community

Formal partnerships (e.g., contracts agreements)

Informal connections (e.g., acquaintances, casual contacts)

Personal ties (e.g., friends, family)

Professional networks (e.g., colleagues, industry contacts)

Community involvement (e.g., volunteering, local events)

Other (please describe)

Please briefly describe your connection to this community

Population of this community at last census count

CDRZ and Other Community Designations

Community is associated with CDRZ Group(s):

– Fill Out Other Fields –

When you established contact, did the community already know it had one or more CDRZ designation(s)?

How did they learn of their CDRZ designation?

Comments

When you established contact, did the community know what a CDRZ designation entails?

Comments

Before you established contact, had the community taken advantage of any CDRZ designation benefits to date?

Which benefits?

Comments

Select all other designations this community has

CEJEST Disadvantaged

Community Resilience Challenges Index

Other (please describe)

If CEJEST Disadvantaged, please describe

If Community Resilience Challenges Index, please describe

If other designations, please describe

Engagement and Assistance

Have you contacted this community?

If yes, did the community accept the assistance you offered?

Comments on the community's response to the offer for help

If no, do you know why they did not accept the assistance you offered?

Limited capacity or bandwidth

Not interested

Services did not match need

Lack of trust

Do not know

Other (please describe)

Please describe other reasons the community has declined assistance

If no, why haven’t you conducted outreach to X community?

Limited capacity or bandwidth

No contact identified in CDRZ

Community does not meet profile of assistance

Other (please describe)

Please describe other reasons you have not conducted outreach to this community

Navigator Work Agreement

Confirm

Agreement is in place to govern relationship between this community and Navigator

Upload signed agreement

Accepted file types: pdf, Max. file size: 1 MB.