MGA Workshop Presenter Follow-Up Information
Please fill out this form with all appropriate information and submit as soon as possible after the workshop to receive payment. For team presentations, both presenters must submit a completed form. Any questions please contact mga@cmich.edu.
Presenter's Name:
Your answer
Home Address:
Your answer
Workshop Name/Topic:
Your answer
Brief Description of the workshop:
Your answer
Goal
Workshop Location
Your answer
Zip Code
If Known
Your answer
Number of Participants
Your answer
Which MGA Strategic Intiatives were supported through this program?
Please check the specific subjects targeted by this program:
(Check all that apply)
Please check all the specific skills or content covered by this program:
(Check all that apply)
Date of Workshop:
MM
/
DD
/
YYYY
Time of Workshop
(ie. 12:00 PM- 4:00 PM)
Your answer
Program Type:
Specify the approximate number of teachers in the following categories?
0-10
10-20
20-30
30-40
40-50
50+
K-2nd In-service Teachers
3rd-5th In Service Teachers
6th-8th In Service Teachers
9th-12th In Service Teachers
Pre-Service Teachers
Post-Secondary
Other
Which incentives, if any, were provided?
Which MGA materials were distributed at the workshop?
Was a fee charged?
Did you conduct an evaluation of this program?
If yes, please provide a brief summary:
Your answer
Reimbursement Request
Please select all that apply:
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