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* 1. First Name

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* 2. Last Name

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* 3. Type of grant you received

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* 4. Primary email address

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* 5. Secondary email address

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* 6. Personal Phone Number

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* 7. School Name

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* 8. School District

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* 9. Provide a brief description of your project or travel experience. Include what the money was used for and how you or your school and/or C-GEO benefited. (250-300 word limit)

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* 10. Were any additional activities (outside the original scope of the grant) presented? If so, please describe.

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* 11. Provide the estimated number of hours you spent working on this program

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* 12. Target Audience(s) - check all that apply

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* 13. How many target audience members were impacted through this grant funding. If possible provide numbers for each audience type.

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* 14. What was successful about your project?

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* 15. Please provide some reactions (quotes) from participants and/or evaluation data that provides evidence on the success of this effort.

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* 16. How did your students' (or your other target audiences's) understanding or appreciation of geography change during your project? Please describe.

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* 17. Would you be willing to give a presentation on your project at the next GeoFest conference (typically every March).

*If you select Yes or Maybe we will contact you directly to discuss further

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* 18. If you received a Teacher Incentive grant, please answer the following two questions. 


Describe how you included your new geographic resources into your classroom.

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* 19. Please list the different types of teaching materials purchased/utilized.

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* 20. If you received a family geography night grant please answer the following nine questions.

What was the date of your Family Geography Night?

Date

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* 21. Would you be willing to serve as a mentor to someone near you that is interested in conducting a FGN?

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* 22. How many student helpers were involved in conducting this effort?

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* 23. How many volunteers were involved in conducting this effort?

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* 24. Did you invite a legislator to your event, as required in the terms of the grant?

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* 25. Who did you invite?

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* 26. Did she or he attend?

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* 27. Did your project receive any media attention? If so, please share the web link to where the story ran.

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* 28. If you received a Travel Grant, please answer the following four questions.

If you attended a conference, what was the name of the conference?

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* 29. If you gave a presentation, what was the title of your presentation and how many attendees were at your presentation?

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* 30. What benefits did you derive that will help you professionally, and how the experience may have enhanced your knowledge of geography and your ability to integrate it into your teaching

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* 31. Do you have any additional information that you would like to share about your experience based upon this grant opportunity?

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* 32. If at all possible, please attach up to five high quality photos of you and your students participating in your project. (File size limit 10 MB)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 33. If attaching photos, please attach one scanned document of the signed photo release forms of students who appear in the photos.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 34. Did you adapt, create or identify a resource or a lesson plan that could be added to the C-GEO web-page of resources?  If so, please share these resources below.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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