A r c h i v e d  I n f o r m a t i o n

Making Information Work for You - 1997

Sample Form for Recording Services

Ongoing Services Provided

Site:________________________________ 

Recorder: ___________________________ 

Date Recorded: ______________________ 
 

Using this form, please describe classes, workshops, newsletters, screenings, or other information or service programs provided to community members. Please note if this is the first time this service has been provided in the community.

Date (M/D/Y)

Ongoing Service

Location of Service

No. of People Attending

New Service?

         
 
 		        
 
 		        
 
 		        
 
 		        
 
 		        
 
 		        

      Please send this form to the evaluators by the first Friday of every month.

Source: Adapted from Fawcett (1994), p. 24.  

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[Explanation of Forms for Recording Activities] [Table of Contents] [Sample Encounter Log]