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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