MICHIGAN PT Scholar and Storyteller Final Report Fall 2011 Survey

1.What is your PRIME TIME Role?(Required.)

2.Click to select the name of your PRIME TIME site.(Required.)

3.Please provide the information requested below.(Required.)

Name:

Home Address:

Home Address 2:

City/Town:

State:

ZIP:

Email Address:

Verify Email Address:

4.If you were unable to attend any sessions, please click to indicate which. Select all that apply.

Please list the name of the scholar or storyteller who filled in for you during the missed session(s).

5.Please estimate the number of hours you spent planning, organizing, and implementing the PRIME TIME program. (Data provides a more accurate picture of the costs of PRIME TIME)
(Required.)

Total Planning/Preparation Hours

MICHIGAN PT Scholar and Storyteller Final Report Fall 2011

PERSONAL INFORMATION