<p>Facilitator Information:</p><p>Name Title or position ______Address ______Phone Email: ______Final list of additional facilitators (list names, titles, & locations) ______Additional workshop assistants (non-facilitators) ______</p><p>Type of Workshop (choose one):</p><p>____Project WILD ____ Growing UP WILD (GUW) ____Flying WILD</p><p>____Wild About Elk ____WILD Science & Civics: Sustaining Wildlife</p><p>____Other (such as Advanced Project WILD, combo workshops, etc; please explain) </p><p>______Workshop Information:</p><p>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? ______</p><p>______</p><p>Did you charge for the workshop? _ Yes __ No If yes, how much? ______</p><p>Besides the workshop curriculum, what other materials did the participants receive? ______</p><p>______# of WILD/GUW books to be returned to Coordinator?</p><p>______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.</p><p>April 2017 Continued on next page Participant Information: Total Number of Participants:______</p><p>Total # for each group: (Required for reporting purposes)</p><p>_____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):______</p><p>Overall participant response (circle one) : a. exceptionally enthusiastic c. somewhat disinterested b. generally interested d. not at all interested</p><p>Act 48 Hours Information:</p><p>Does PA State Parks need to process the Act 48 hours for your workshop? Yes ___ No</p><p>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).</p><p>Self Evaluation: What activity or segment of the workshop do you think was most successful? Why? ______What was the least successful? Why? ______</p><p>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? ______</p><p>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: </p><p>Carissa Longo, PA Project WILD Coordinator DCNR-Bureau of State Parks 400 Market St., 8th floor; Harrisburg, PA 17101 </p><p>April 2017 Phone: 717.772.1807 │ [email protected] │ Fax: 717.787.8817</p><p>April 2017</p>