Final Report 2019 Seat Belts Save Challenge

Thank you for participating in the 2019 Seat Belts save challenge! Please fill out this final report form by December 16, 2019 for a chance to win one of three $1,500 prizes for your school or organization!

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Thanks to our generous sponsor!

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* 1. Teacher/Advisor Contact Information

Name *

School/Organization *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Student Leader #1 Name

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* 3. Student Leader #2 Name

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* 4. Youth Participating Organization (include if this activity was part of club activities (BPA, DECA, FBLA, FFA, SADD)

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* 5. What was the total estimated number of student participants for the entire campaign?

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* 6. Date of 1st Seat Belt Check

Please enter date of first seat belt check

Date

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* 7. 1st Seat Belt Check - What was the total number of cars checked?

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* 8. 1st Seat Belt Check - What was the total number of people belted?

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* 9. 1st Seat Belt Check - What was the total number of people NOT belted?

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* 10. Please attach copies of seat belt check forms from the 1st Seat Belt Check

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 11. Please attach any additional copies

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 12. Please attach any additional copies

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 13. Date of 2nd Seat Belt Check

Please enter date of first seat belt check

Date

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* 14. 2nd Seat Belt Check - What was the total number of cars checked?

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* 15. 2nd Seat Belt Check - What was the total number of people belted?

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* 16. 2nd Seat Belt Check - What was the total number of people NOT belted?

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* 17. Please attach copies of seat belt check forms from the 2nd Seat Belt Check

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 18. Please attach any additional copies

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 19. Please attach any additional copies

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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* 20. Did you have a kick off event? If so, tell us a little bit about it! (25 points)

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* 21. Did you have a social media campaign? (20 points)

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* 22. Did you promote the challenge? (25 points)

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* 23. Did your campaign include community outreach? (20 points)

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* 24. Did you include any innovative activities? (10 points)

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* 25. Please attach a photo from the kick off event, social media campaign, promotion or other activities if you have it!

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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* 26. Please attach an additional photo if you would like.

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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* 27. Please attach an additional photo if you would like.

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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* 28. Please attach an additional photo if you would like.

File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File