Program Facilitator Check-In Form
Please complete the Program Facilitator Check-In Form to share your experience and feedback for your recent session.
Facilitator Full Name
*
First Name
Last Name
Date of Check-In
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which program did you facilitate today?
*
Please Select
Youth Leadership Workshop
STEM Enrichment Session
Community Outreach Event
Career Readiness Seminar
Other
How would you rate the overall session?
*
1
2
3
4
5
Session Status
*
Completed as planned
Partially completed
Postponed
Cancelled
Which challenges did you encounter? (Select all that apply)
Low participant engagement
Technical difficulties
Time constraints
Resource limitations
None
Other
Please indicate your satisfaction with the following aspects:
*
Rows
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Participant engagement
1
2
3
4
5
Available resources
6
7
8
9
10
Session materials
11
12
13
14
15
Support from staff
16
17
18
19
20
What went well during the session?
What could be improved for future sessions?
Do you need additional support?
*
Yes
No
Submit
Should be Empty: