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Program Evaluation Form

Name of Program:


Contact Person (first and last name):




Did you actually adapt and use this program?


When did you start to use this program?

   Number of people involved

If there were costs involved, please tell us how much it cost and how the costs were funded:

Did the program meet your expectations?

Please tell us briefly, what worked?

What didn't work?

What changes would you suggest for the next potential Program User?

With your suggested changes, would you recommend the program to others?

Do you have a summary or other overview of your program?
(if Yes, please attach below)

Do you have a logo, photos, or other promotional material we could use of this site?
(if Yes, please attach below)

Please tell us how you want us to word the credit.

Any additional comments?

Please attach relevant support materials: (acceptable files types are jpg, png, gif, pdf, doc, docx, ppt)

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An email of acknowledgement, including your above responses, will be sent to you.