Are you prepared for an emergency?

1. R U Prepared? Reporting Form

Thank you for participating in the R U Prepared? program for Emergency Preparedness Month. Please take a couple of minutes to report your emergency number promotion activities.

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* 1. Estimated number of school staff:

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* 2. Estimated number of students that attend your school:

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* 3. State

Maine

New Hampshire

Vermont

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* 4. Please fill in the information for your school.

School Name:

Address:

Address 2:

City/Town:

ZIP/Postal Code:

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* 5. Please provide information for a key contact person.

Name:

Email Address:

Phone Number:

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* 6. Grades included:

Other (please specify)

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* 7. How valuable did you find this activity?

Very

Somewhat

Not sure

Not very

Not at all

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* 8. How likely is your school to participate in a similar activity next year?

Very

Somewhat

Not sure

Not very

Not at all

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* 1. Estimated number of school staff:

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* 2. Estimated number of students that attend your school:

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* 3. State

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* 4. Please fill in the information for your school.

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* 5. Please provide information for a key contact person.

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* 6. Grades included:

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* 7. How valuable did you find this activity?

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* 8. How likely is your school to participate in a similar activity next year?

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* 9. Please provide a brief summary of the activities your school did.