Screening: Data Collection Form Organization* Screening Location* Screening Date* MM slash DD slash YYYY Number of people screened*Number of people with below threshold score*Number of other individuals who did not get screened, but came in to pick up educational materials and participate in other activities you offeredUpload file(s)Additionally, please upload any completed Voluntary Participant Surveys. If you are having trouble uploading the surveys, please submit them by using one of the following options: • Email – screening@alzfdn.org • Fax- 646-638-1546 • Mail- National Program Coordinator, 322 8th Ave, 7th Floor, New York, NY 10001 Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 128 MB. CAPTCHA
Screening: Data Collection Form Organization* Screening Location* Screening Date* MM slash DD slash YYYY Number of people screened*Number of people with below threshold score*Number of other individuals who did not get screened, but came in to pick up educational materials and participate in other activities you offeredUpload file(s)Additionally, please upload any completed Voluntary Participant Surveys. If you are having trouble uploading the surveys, please submit them by using one of the following options: • Email – screening@alzfdn.org • Fax- 646-638-1546 • Mail- National Program Coordinator, 322 8th Ave, 7th Floor, New York, NY 10001 Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 128 MB. CAPTCHA
