TUPE Activity Log

Please describe below any Tobacco Use Prevention Education (TUPE) activities at your school site.

Please submit one entry per activity.

NOTE: Incentives must be no more than $25 per student per year
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Email *
First and Last Name: *
School Year *
School District: *
School Name (please no acronyms): *
Date(s) TUPE Activity/Meeting Was Held: *
What Activity(ies) Took Place? *
If other, please provide a brief description of the activity.
Was your activity held during any of the following? *
Who led the activity?
Number of Students Who Participated in the Activity *
Approximate is ok. If you did multiple activities, please add the total number of all the students who participated per activity from all the schools. This includes students reached by the activity.
Who was the audience? *
What materials were given at the activity (select all that apply): *
What worked well regarding the planning and implementation of this activity?
How may the planning and implementation of this activity be improved in the future?
A copy of your responses will be emailed to the address you provided.
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