Kaity's Way Post Event Data Gathering
Thank you for filling out this form. The information you are about to provide helps Kaity's Way in so many ways. We are able to determine our costs as well as show potential donors how active we are in the community and that the population we serve is very diverse on so many levels.
Event Date and Start time
MM
/
DD
/
YYYY
Time
:
Event/Venue Name
Your answer
Event Location Street Address
Your answer
Event City, State, Zip
Your answer
Name of person completing this form
Your answer
Names of any volunteers that helped with the event
if no one else helped just indicate none
Your answer
Facilitators Time of Arrival to the Event
Facilitator is the lead person for the event. This time is usually earlier than the time of the event to allow for set up
Time
:
Time of Departure from the Event
Time
:
Time spent setting up and breaking down
This time frame should include requests to stay behind for additional Q&A or required early arrival
Hrs
:
Min
:
Sec
Actual time spent Presenting
Hrs
:
Min
:
Sec
Travel Cost/Expenses
Travel Time
Round trip
Hrs
:
Min
:
Sec
Air, Bus, Train transportation cost
If applicable, indicate total cost for ticket(s)... if not, put 0
Your answer
Mileage
How many miles were traveled to get to and from the event
Your answer
Car rental fee
If so, indicate amount of rental fee. If not, indicate 0 (number zero)
Your answer
Gas for trip
If so, indicate amount below. If not, indicate 0 (number zero)
Your answer
Lodging cost
If so, indicate amount below. If not, indicate 0 (number zero)
Your answer
Per Diem
If so, indicate amount below. If not, indicate 0 (number zero)
Your answer
Population Served
This data is gathered for reporting and grant writing purposes

Please follow directions carefully

Ethnicity
Indicate the number of people in the audience that appeared to be of the following ethnicities.
Put 0 (number zero) if there were none
Caucasion
Indicate number of people in audience that appeared Caucasion
Your answer
Native American
Indicate number of people in audience that appeared Native American
Your answer
Hispanic
Indicate number of people in audience that appeared Hispanic
Your answer
African American
Indicate number of people in audience that appeared African American
Your answer
Asian
Indicate number of people in audience that appeared Asian
Your answer
Middle Eastern
Indicate number of people in audience that appeared Middle Eastern
Your answer
Other
Indicate number of people in audience that appeared to be other than the above mentioned ethinicities
Your answer
Gender
Male
Indicate number of males in the audience
Your answer
Female
Indicate number of females in the audience
Your answer
Age
12 yrs - 15 yrs
Indicate number of audience members that appeared to be in this age range. 0 (number zero) for None
Your answer
16 yrs - 18 yrs
Indicate number of audience members that appeared to be in this age range. 0 (number zero) for None
Your answer
19 yrs - 24 yrs
Indicate number of audience members that appeared to be in this age range. 0 (number zero) for None
Your answer
25 yrs and older
Indicate number of audience members that appeared to be in this age range. 0 (number zero) for None
Your answer
Material Costs
This area is the keep track of the cost of materials provided to the community.

Please indicate number of each item given out at the event.
0 (number zero for None)

Kaity's Way Brochure - English
Your answer
Kaity's Way Brochure - Spanish
Your answer
P.E.A.C.E./KL Sp 2 sided
Your answer
Teen Power & Control Wheel (Eng/Sp) 2 sided
Your answer
LGBTQ Power & Control Wheel (Eng/Sp) 2 sided
Your answer
CDC TDV Information 2 sided
Your answer
Bracelets
Your answer
Prizes
Your answer
Admin Paperwork
Event set up form, sign in sheets, etc
Your answer
Pre Survey 1 side
Your answer
Post Survey 2 side
Your answer
Was an Honorarium provided?
If so, indicate amount below
Your answer
What type of Event was this
Comments
Your answer
Number in Attendance
Estimate the number of people that attended the event
Your answer
Number of people served
This number for a presentation will be the same as number in attendance. For a resource table record the number of people that stopped by the table.
Your answer
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