This universal cover sheet (revised September 2012) replaces all other cover sheets and should be used for all scan forms. Print and complete it.
The cover sheet must be completed in full and included with any scan forms submitted to Organizational Development. Information from the cover sheet allows us to track your forms and aggregate results for reporting impacts at various levels (state, region, county, individual, etc.).
Note: Any survey forms received without the cover sheet are listed in the “Problem Forms” log and placed on hold until the cover sheet is submitted.
Updates on 09-14-12: New agency logo. New fields added for CEP, partial cost recovery, and zip code where the activity occurred. State goals updated. Access to Personnel Directory included as a link. Mailing address at the bottom of the form.