Texas PLT Program Reporting Form
Name
Your answer
Phone
Your answer
Email Address
Your answer
Name of School or Sponsoring Organization(s)
Your answer
Date
Program/Activity took place on:
MM
/
DD
/
YYYY
Is this Program/Activity ongoing throughout the school year?
Number of Participants
Your answer
Audience
(check all that apply)
Type of Presentation
Check all that apply
Additional comments about how and where PLT activities were used.
Your answer
Please estimate the number of hours you spent preparing for the program/activity.
Your answer
Please estimate the number of hours you spent following up on the program/activity.
Your answer
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