VERA 2016 Reporting Form

Thank you for taking the time to report your VERA results! Please fill in something in each box, even a zero or N/A.

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* 1. Program Information

Program Name

Address

City

State

ZIP

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* 2. Person completing this form:

Name

Title

Email Address

Phone Number

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* 3. How many students in your program participated in VERA-related activities?

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* 4. How many of your students:

were already registered voters?

registered to vote?

voted?

voted for the first time?

were not eligible to vote?

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* 5. Which of the VERA resources did you find useful?

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* 6. Do you have student writings, stories and quotes, or any lessons you'd like to share? If so, please email them to anash@worlded.org.

Yes, I will send you an email!

I have nothing to share.