NIPD Program/Event Submission Form


Important: If your site is doing multiple things for NIPD, please submit this form multiple times, each item in the correct category. For "Shining a Green Light," please make an entry for each building that is being lit.

Prior to NIPD / your event: Please provide information about what you plan to do on NIPD. We understand it may not happen exactly like this. You can come back and edit this information as often as needed to keep it up to date with your plans.

AFTER NIPD: Please return to this page and edit it, changing the information to reflect what actually took place. This will help us prepare a report after the day.

NIPD Year:
Program Title:
(For "Shining a Green Light", the program title should be the building name.)
Umbrella Partner(s):

Select the NIPD parnter(s) under which your organization and this event falls. In some cases, an event may be under two or more umbrella partners, for instance sites that are members of both Injury Free Coalition for Kids and Safe Kids Worldwide.

Injury Free Coalition for Kids
American Academy of Pediatrics (AAP)
American Trauma Society (ATS)
Be SMART -- a program of Everytown for Gun Safety Support Fund
Giffords Gun Owners for Safety
I'm Safe
JPMA Cares
Safe Kids Worldwide
Safe States Alliance
Society for Advancement of Violence and Injury Research (SAVIR)
Trauma Center Association of America (TCAA)
Unafilliated local partner

Program Type:

City, State:
(Please provide as city, state abbreviation. For example: "Philadelphia, PA".)


After your event has taken place, please include in the description additional information about the event:

  • number of people involved (employees and volunteers)
  • number of lives touched
  • duration time (start time-end time)
  • amount of equipment distributed
  • new or strengthened coalition partnerships/relationships
  • any other useful measure of your program's effectiveness

Links to media coverage can be included in the Links/Attachments section, or can be included in the description.

This event has taken place and I've updated the information on this page to reflect what took place.
Dates and Times:
URL for More Info:

Contact Name:
Contact E-mail:
Contact Phone:
Make contact information public on the NIPD page.

Staff Notes:
Staff notes are for NIPD staff only and are not visible to the public.

IMPORTANT NOTE: Please be sure to click the Submit button ONLY ONCE.


Attachment/Link Instructions

Please don't use this section for photos or videos. Use the "Add photo" link on the event page.

You may upload any publicity materials or other documents you may have created. Any attachments to this entry will be public.

To upload a file, fill in the Title field and click Browse... to select the file to upload. If you are editing an existing record, and a previously uploaded file has not changed, YOU DO NOT NEED TO UPLOAD IT AGAIN. Only upload a file again if it has changed.

  Attachment #1 Title: URL: Upload File:
  Attachment #2 Title: URL: Upload File:
  Attachment #3 Title: URL: Upload File:
  Attachment #4 Title: URL: Upload File:
  Attachment #5 Title: URL: Upload File: