WiSTEM2D Evaluation

Team leads should use this form to record the activity conducted and the number of attendees, including total number of students, number of female students, and number of volunteers. If your activity/event is recurring, you need to complete this worksheet only once. (For example, if you have an event that occurs weekly over the course of the academic year for the same group of girls and the same group of volunteers, you will complete only one program data collection worksheet for this event, not for each occurrence.)

* 1. Event ID:
(Please contact your Regional Champion or Jamie Watkins (jwatki12@its.jnj.com) if you don't have an Event ID)

* 2. Event/Team Lead Contact Information:

* 3. Event/Team Lead Contact Information:

* 4. Date of the event (If event spans multiple days enter the first day):

Date / Time

* 5. Brief description of the activity/event:

* 6. Location of the activity/event:

* 7. Is the activity/event an existing activity/event (that is, J&J employees are joining or adding to an event that has already existed separately from this J&J WiSTEM2D initiative)?

* 8. Type of activity/event (choose one):

* 9. Duration of the activity/event in a day (choose one):

* 10. One-time event?

* 11. If not a one-time event, indicate the frequency (choose one):

* 12. Did you work with a partner for this activity/event? Check all that apply.

* 13. Did you receive SPARK WiSTEM2D training?

* 14. Did you use the content in SPARK WiSTEM2D?

* 15. Did you conduct an activity from the STEM2D Student Activity Series?

* 16. If you answered "yes" to number 14, please provide the name of the activity(ies):

* 17. Content area (check all that apply):

* 18. Students served:

* 19. Total number of attendees (students):

* 20. Number of female students participating:

* 21. Number of J&J employees volunteering:

T