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Ag in the Classroom Reporting Form
In Person live or virtual Classroom or Student Event Presentation
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Email
*
Your email
Name of Person Reporting
*
Your answer
Phone Number
*
Your answer
Cattlewomen Unit Reporting
*
Alameda
Amador/El Dorado/ Sacramento
Butte
Calaveras Toulumne
Fresno Kings
Glenn Colusa
Humbolt
Imperial
Intermountain
Inyo Mono
Kern
Lassen
Madera
Mendocino
Mid-Valley Cowlbelles
Modoc
Monterey
Napa Solano
Placer Nevada
Plumas Sierra
San Benito
San Diego
San Joaquin Stanislaus
San Luis Obispo
Santa Barbara
Santa Clara
Shasta
Siskiyou
Sonoma Marin
Tehama
Tulare
Yuba Sutter
I'm not sure
Type of Activity
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Classroom in Person Lesson
Classroom virtual Lesson
In Person All Student Activity Outside the Classroom (ie Farm Day in the City, 4-H, FFA, Scouts, Community Event Childrens Activity
Event Date
*
MM
/
DD
/
YYYY
Location of In Person Event
*
Your answer
Grade Level of Audience / Intended Audience
Your answer
Number of Students Reached -
*
Please include only those who attended the presentation, not the entire community or field day event attendance
Your answer
Number of Replays of the original virtual lesson presentation - complete if known, otherwise enter 0
*
Your answer
Length of Presentation (in hours)
*
Your answer
Number of Times Presented
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Your answer
Total Cattlewomen Hours volunteered for the event or activity (travel to and from, preparation, presentation, and cleanup)
*
Your answer
Total Print Media Impressions -ie TV, Radio and Newspaper
*
Your answer
Total Social Media Impressions - Social Media
*
Your answer
Did you use materials Provided by
*
California Beef Council
California Ag in the Classroom Foundation
Video or Media from Other CCW Units
Other:
Share more details about your event!
*
Your answer
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