Program Implementation Assessment Form
(Minimum required fields marked with an asterisk(*). Other fields may be required based on input.) |
| * Program area focus: |
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| * Calendar Year: |
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| * Date of event: |
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| * Number of service hours of event: |
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| * Venue Activity Location: |
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| * Program Description: |
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| * Program Goals: |
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| * # People provide materials: |
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| * # Members participated event: |
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| National Partner fundraising event: |
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| Health event: |
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| Bigger Better Business event: |
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| Education event: |
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| Outside moderator/speaker: |
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| Last scholarship funds dispers: |
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| Were funds dispersed? |
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| Dispursement Type: |
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| Funds Recipient: |
Other:
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| Amount Disbursed: |
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| Type of media coverage: |
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| Event Pictures: |
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| Picture Comments: |
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| Event Video: |
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| Video Comments: |
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| * Rate event success: |
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| * Recommended program in future: |
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| Additional Comments: |
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| Additional Documentation: |
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