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* 1. Today's Date

Date

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* 2. School District

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* 3. School Name

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* 4. Address:

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* 5. Program Teacher

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* 6. Best Email Address

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* 7. Alternate Contact Name:

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* 8. Alternate Contact Email:

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* 9. Reporting Period:
Month/Year Started- Month/Year Ended

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* 10. How many years has your school been a part of the Femineer® Program

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* 13. How many students are in the Femineer®Program at your school ?

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* 14. Upload your Femineers® pictures

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

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* 15. How many cohorts do you have ?

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* 16. Describe activities undertaken this year, including outcomes and lessons learned of your Femineer® Program this school year.  (Feel free to include any links, articles) ( Please email any pictures you would like to share to cpp_we@cpp.edu)

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* 17. Discuss Future Plans
List the Femineer® Program activities to be pursued during the next school year and note whether and how they involve modification.

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* 18. Please answer the following only if the Femineer® Program at your school is terminating:
a.
Please list the reason(s) for the Femineer® Program terminating at your school.

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* 19. b. What advice would you give to anyone who is considering bringing the Femineer® to their school?

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