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!

Thanks to our generous sponsor!

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* 1. Teacher/Advisor Contact Information

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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

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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 

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen

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* 11. Please attach any additional copies 

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* 12. Please attach any additional copies 

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* 13. Date of 2nd Seat Belt Check

Please enter date of first seat belt check

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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

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen

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* 18. Please attach any additional copies 

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* 19. Please attach any additional copies 

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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!

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

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

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

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