Indigenous Male Health Program
 Contribution Form

This project aims to improve Indigenous male health in Australia by encouraging workers to document and share their work. 

Use this entry form in NETSCAPE NAVIGATOR ONLY to provide a contribution for inclusion.

(PLEASE NOTE: IF YOU ARE USING INTERNET EXPLORER YOUR CONTRIBUTION WILL NOT BE SENT TO PROPERLY FROM THIS SITE  - thanks to Bill Gates and his team at Microsoft).

The information contributed will be displayed on this website for others to review, learn from and adapt for their own purposes.

Title

Title: of program/activity

Contact details

Contact person: Who can Indigenous male health workers contact about this program or activity?
Position: what position does the contact person hold?

email address:
Producing agency: Name of your organisation. Include Division, Branch Section etc where appropriate.
Address of producing agency: Please supply your postal address
Phone:
Fax:
Who developed the program or activity? Please list people involved if other than contact person
Funded by: who by or how was the program funded

About the project or material

Target group: Who is the intended audience(s) of the program or activity e.g. general male public, young males, elderly, other specific group, etc?
Goals:
What is this program or activity seeking to achieve?
Description: Briefly describe the program or. What? When? Where? How?
Language(s): is the program or activity written up in a language other than English?
Format: e.g. men's night out,  2 day workshop, weekly meetings?
The date the program or activity began:  Is the activity/program ongoing?
Strategy used:   Please click the boxes that best describe your strategy Develop personal skills and knowledge

Reorient health systems towards primary health care

Encourage Healthy Public Policy

Create healthy and supportive environments

Increase community Action

Other (please describe below)

What health issues does the program or activity address?
How did you identify the issues that are addressed? Why has the selected method been chosen? What consultations took place on the need for the project?
Achieved or Anticipated Outcomes: What has happened/will happen as a result of your work
What is working/has worked? Briefly describe the elements of this program that you consider successful
What is not working/has not worked? Briefly describe the elements of this program that you feel were not successful
Evaluation:  Has any program evaluation taken place:  Please tick the appropriate box Not thought about

Designed and Planned

In progress

Completed

Was an external unit involved in the evaluation? If so who?
Details of any evaluation instruments or protocols developed for this project:

How can potential users access your work?

Availability of project materials and information about this project

Are copies of program  reports/materials available to other Indigenous Male Health workers who might want to trial them?

Please tick the appropriate box

No - personal contact only

Copies available for sale - Price

Copies available for wide distribution

Copies available for loan

Limited numbers or restricted circulation

Other (please provide details below)

Is project documentation available? Record of planning

Resource materials

Record of actual program

No documents available. Personal contact only

Final report

If materials or documentation are available from anyone other than the listed contact person (eg in a library) or the contributing agency, please give contact details here

 Organisation
 

Contact
 

Position
 

Phone: Fax:

Email:

Thanks for your co-operation:

Please indicate if you require acknowledgment of receipt of this form

Now press the send entry button to email your contribution form

to the Indigenous Male Health Web Site:

 

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