Introduction and Contact Information

 
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Purpose:
The purpose of this log is to assess and document fidelity in implementation of the Promoting Health Among Teens Comprehensive (PHAT-C) curriculum in school settings.

The following fidelity log is for facilitators who were trained in PHAT-C by the Personal Responsibility Education Program (PREP) through the NC School Health Training Center AND have implemented the PHAT-C curriculum.

Instructions
:
Please submit a fidelity log entry following the completion of the PHAT-C curriculum. For each class period, one facilitator should submit one data entry describing the group of students who were taught the PHAT-C curriculum, even if more than one facilitator led the group. Each facilitator who led or co-led the PHAT-C curriculum during the class period will receive a $20 Amazon gift card after the fidelity log entry is completed AND an attendance report for the class period has been submitted. If you co-facilitated the curriculum for the class period, please have the name and mailing address of the other facilitator on hand. For each of the activities in the lessons, please indicate whether you completed the activity as described in the curriculum, modified it, or did not implement the activity. Modifications might include adding current data or changing the way you teach something (e.g. making something into a game, using pairs instead of small groups for an activity, customizing role plays, adding additional questions during discussion and/or shortening an activity due to lack of time).

Questions with an asterisk require a response. When you have completed the log, please provide your mailing address and any co-facilitator's mailing address for your gift cards and select the "DONE" button at the bottom. You and any other co-facilitator will receive a $20 Amazon gift card from East Carolina University within 4-6 weeks after submission of both the fidelity log entry and the attendance report.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Work Email Address:

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* 4. Contact Information:

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* 7. If other is selected, please list name of school or community based organization:

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