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

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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. Of the total above, how many attendees fall into the following categories (the total should add up to your response in Q13). Please provide your best estimate.

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* 15. Of the total above, how many attendees are of the following race (the totals should add up to your response in Q13).
Please provide your best estimate, knowing that an individual can be multi-racial. This data helps APA evaluate the Ambassador program.

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* 16. Of the total above, how many attendees are of the following Hispanic origin (the answers should add up to your response in Q13) Please provide your best estimate. This data helps APA evaluate the Ambassador program.

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* 17. Of the total above, how many attendees are of the following gender (the answers should add up to your response in Q13) Please provide your best estimate. This data helps APA evaluate the Ambassador program.

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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?

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