Project WILD Workshop Proposal

Facilitator Information:

Name Title or position ______Address ______Phone Email: ______Final list of additional facilitators (list names, titles, & locations) ______Additional workshop assistants (non-facilitators) ______

Type of Workshop (choose one):

____Project WILD ____ Growing UP WILD (GUW) ____Flying WILD

____Wild About Elk ____WILD Science & Civics: Sustaining Wildlife

____Other (such as Advanced Project WILD, combo workshops, etc; please explain)

______Workshop Information:

Date(s) of workshop: ______Type of training (circle one): a. public workshop e. institute (17+ hour course) b. private workshop f. portion of institute/course c. school in-service workshop (private) g. College/University Pre-service Teachers h. other ______How did you advertise/promote this workshop? ______

______

Did you charge for the workshop? _ Yes __ No If yes, how much? ______

Besides the workshop curriculum, what other materials did the participants receive? ______

______# of WILD/GUW books to be returned to Coordinator?

______Amount now owed to DCNR (WILD = $16.50/book; GUW = $17.50/book). Please pay via check (made out to: Commonwealth of PA). Lack of payment will affect your WILD/GUW Facilitator status.

April 2017 Continued on next page Participant Information: Total Number of Participants:______

Total # for each group: (Required for reporting purposes)

_____elementary teachers (K-5) _____resource agency personnel _____head start/pre-school _____secondary teachers (6-8) _____principals _____college students (not pre-service teachers) _____high school teachers (9-12) _____naturalists _____college faculty _____superintendents _____youth organizations _____pre-service teachers (college) _____curriculum specialists _____private conservation group _____other (list):______

Overall participant response (circle one) : a. exceptionally enthusiastic c. somewhat disinterested b. generally interested d. not at all interested

Act 48 Hours Information:

Does PA State Parks need to process the Act 48 hours for your workshop? Yes ___ No

1. If YES, please include the completed Act 48 Hours sign-in sheet with this form. PPID#’s are seven digits. 2. If YES, what is the percentage of participant improvement from pre to post test: ______% Ex: If all participants scores improved on the post test, the percentage of improvement would be 100% (this data is needed for Act 48 reporting).

Self Evaluation: What activity or segment of the workshop do you think was most successful? Why? ______What was the least successful? Why? ______

What did YOU learn while leading this workshop? ______Based on your experience, would you make any changes to your agenda or to your workshop format? ______

Please email or fax this form along with your final agenda, copies of evaluations, and completed Act 48 hours sign-in sheet (if needed) to:

Carissa Longo, PA Project WILD Coordinator DCNR-Bureau of State Parks 400 Market St., 8th floor; Harrisburg, PA 17101

April 2017 Phone: 717.772.1807 │ [email protected] │ Fax: 717.787.8817

April 2017