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Program Implementer:
Session#: Title:
Activity	Number of participants (e.g., parents, students)	Activity completed? (yes/no)	If no, what was left out?	What was added or changed?	Time spent on activity	Problems encountered	Attempted solutions	Successes achieved	Lessons learned
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For example:

Program Implementer: Sandy Mitchell
Session#: 3 Title: Setting a Health Goal
Activity	Number of participants (e.g., parents, students)	Activity completed? (yes/no)	If no, what was left out?	What was added or changed?	Time spent on activity	Problems encountered	Attempted solutions	Successes achieved	Lessons learned
1. Define "goal"	25	Yes		Talked about related terms, like objectives -- but also hopes and dreams	5-7 minutes	Hard to engage students in this topic; they didn't find it interesting at first	Talked about hopes and dreams thinking these terms might engage them more		May need to add more colorful language to this program when defining terms
2. Brainstorm different health goals	25	Yes		Provided some examples based on health problems I've seen among my students	5-7 minutes	Only a few students offered suggestions; the rest were very quiet	Offered some of my own suggestions and spent less time on this than called for
3. Set a personal health goal	25	Yes			5-7 minutes			They all seemed to set a personal health goal
4. Develop a plan to reach that goal	24 (David H. asked to go to the nurse)	Yes			10-15 minutes	Many students wanted individual assistance developing their plan	Provided quick help to as many students as possible, then offered to talk to them more during break if they wanted		May need to allow for more time than expected for certain program activities

Adapted from ETR Associates. (1997). Dissemination Workbook for Programs That Work. Santa Cruz, CA: Author.