Educational Outreach Impact Report Form
Report key details, outcomes, and feedback from your educational outreach activities.
Program Title
*
Date of Outreach Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Activity (Venue or Online Platform)
*
Type of Outreach Activity
*
Please Select
Workshop
Seminar
School Visit
Webinar
Community Event
Other
Brief Description of the Activity
*
Number of Participants
*
Participant Demographics
Rows
Children (under 13)
Teens (13-18)
Adults (19-64)
Seniors (65+)
Number of Participants
Key Outcomes Achieved
*
Please rate the overall impact of this outreach activity
*
1
2
3
4
5
What challenges did you encounter during this outreach activity?
Lessons learned or suggestions for future outreach activities
Would you recommend continuing or expanding this outreach activity?
*
Yes
No
Not Sure
Contact Person Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Submit Report
Should be Empty: