IN.gov - Skip Navigation

Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.


Subscribe for e-mail updates
Print This Page Rate This Page Suggest a Link E-mail This Page HELP Find a Person Find an Agency

Student Project Report Form

Is this a Category A (Peer Health Presentation) or Category B (Creative Health Project).

Title (or topic):
Name of your school:
Faculty Advisor Name:
Project description:
Project format:
(for example, play, article, poster,
mural, song, health fair, commercial
or ad, community service project, etc.)
Topics your project covered:

Healthy eating or nutrition
Physical activity or exercise
Stopping or preventing tobacco use
Other

Project goal:
(for example, "Participants will learn ___" or
"Participants will do ___." You can have more
than one goal.)
Number of participants:
How did you count them? :
Describe the participants:
(for example, where were they from? About how old were they? etc.)
Project Location:
Where and when did your project occur.
(Example, Terre Haute YMCA, 123 Main St, Terre Haute 12345) 		Where:
Date:
Time:
How did you get feedback? :
(Did participants talk to you afterward? Did they complete a form? Did they send you emails? Did they call you? etc.)
Summarize the feedback? :
(One paragraph. Include positives and negatives.)
What was the best part of your project and why? :
What would you change and why?:
Name of student(s)
working on project:		 Last Name: First Name:
Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
  Last Name: First Name:
   
Contact for this project: Last Name: First Name:
Contact email address:

Please review your information. Whey you are ready, click Submit and your information will be submitted to the INSight Yourth Corps projectmanagement team.

You will receive a confirmation email.