2017 APA Ambassador Year - Activity Report Form

APA Ambassadors: please complete this form for each activity that you conduct (minimum = 2). Please contact ambassadors@planning.org if you have any questions.

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* 1. First name

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* 2. Last name

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* 3. APA ID

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* 4. Name(s) of additional APA Ambassadors that participated in the activity (if applicable)

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* 5. Name of activity

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* 6. Activity description

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* 7. Activity date

Month, day and year the activity took place

Date

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* 8. Activity location (city)

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* 9. Activity location

Washington, DC

Other (please specify)

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* 10. Total amount of volunteering hours spent on activity from initiation (developing your process) to end (submitting activity report)

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* 11. Total $$ amount of money donated

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* 12. Briefly explain overall expenses.

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* 13. Number of attendees at activity

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* 14. What percentage of your audience falls into the following categories (answers should add up to 100)? Please provide your best estimate.

Student - elementary school

Student - middle school

Student - high school

Student - university or college

Community member (non-student)

Professional planner

Other

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* 15. Of your total audience, what percentage are the following race (answers should add up to 100)? Please provide your best estimate, knowing that some individuals are multi-racial.

White

Black or African American

American Indian or Alaska Native

Asian or Pacific Islander (Japanese, Chinese, Korean, Vietnamese, Native Hawain, Filipino, Guamanian or Chamorro, Samoan, or Other Asian/Pacific Islander)

Other/Multi-Racial/I Don't Know

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* 16. Of your total audience, what percentage are of Hispanic origin (answers should add up to 100)? Please provide your best estimate.

Spanish, Hispanic or Latino (Mexican, Mexican American, Chicano, Puerto Rican, Cuban, other Spanish, Hispanic or Latino)

Not Spanish, Hispanic or Latino

Other/I Don't Know

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* 17. Of your total audience, what percentage are the following gender? (answers should add up to 100) Please provide your best estimate.

Male

Female

Other/I Don't Know

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* 18. Observations/lessons learned from activity

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* 19. Please rate your overall satisfaction with the Ambassador activity

Very satisfied

Satisfied

Not sure or neutral

Not satisfied

Other (please specify)

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* 1. First name

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* 2. Last name

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* 3. APA ID

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* 4. Name(s) of additional APA Ambassadors that participated in the activity (if applicable)

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* 5. Name of activity

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* 6. Activity description

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* 7. Activity date

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* 8. Activity location (city)

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* 9. Activity location

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* 10. Total amount of volunteering hours spent on activity from initiation (developing your process) to end (submitting activity report)

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* 11. Total $$ amount of money donated

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* 12. Briefly explain overall expenses.

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* 13. Number of attendees at activity

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* 14. What percentage of your audience falls into the following categories (answers should add up to 100)? Please provide your best estimate.

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* 15. Of your total audience, what percentage are the following race (answers should add up to 100)? Please provide your best estimate, knowing that some individuals are multi-racial.

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* 16. Of your total audience, what percentage are of Hispanic origin (answers should add up to 100)? Please provide your best estimate.

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* 17. Of your total audience, what percentage are the following gender? (answers should add up to 100) Please provide your best estimate.

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* 18. Observations/lessons learned from activity

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* 19. Please rate your overall satisfaction with the Ambassador activity

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* 20. Are there any other comments you'd like to share?