Forms Reports
(For schools to use for their local events.)
SAMPLE AGENDA
HUMAN RIGHTS 101
EDUCATIONAL OUTREACH EVENT
[Insert Date]
LOCATION: [School Name and Address]
AGENDA:
Sign-in and reception30 minutes
Welcome5 minutes
Introduction to Film and Outreach goals5 minutes
Screening of Film or Clip60 minutes – 7 minutes (depending on event)
Guest Speaker/Panel30 minutes (depending on event)
Next Step Ideas10 minutes
Question and Answer Period10 minutes
Wrap-up and Thank You10minutes
(For schools to distribute to their event participants at the conclusion of their local events.)
EVENT PARTICIPANT EVALUATION
WHICH CATEGORY BEST DESCRIBES YOUR SCHOOL?
Please Check One:Urban Suburban Rural
Please Check One:Public Private Parochial
CONTENT OF THE SCREENING AND PANEL DISCUSSION
Please indicate how successful the following elements were in informing participants about please add your topic description here>.
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Forms Reports
Description of the Program
Very SuccessfulNot Successful
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Panelists
Very SuccessfulNot Successful
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Video Clips
Very SuccessfulNot Successful
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Audience Participation
Very SuccessfulNot Successful
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Post-Program Session
Very SuccessfulNot Successful
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Event Packets
Very SuccessfulNot Successful
54321
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Forms Reports
Have you been involved in please fill in your topic description here prior to this event?
Yes___No___
If no, what attracted you to participate in this event?
Are you planning to continue working as a part of a local organization or school surrounding topics the screening raised?
Yes___No___
If no, why not?
If yes, what are your next steps?
Comments
PLEASE PRINT CLEARLY!
This contact information will be used to forward you additional informationabout please fill in your topic here outreach events.
Name:
School or Organization:
Address:
City: State: Zip:
Phone: Fax: Email:
(For grantrecipients to complete at the conclusion of their project.)
SITE MANAGER’S REPORT/EVALUATION FORM
PLEASE PRINT CLEARLY!
CONTACT INFORMATION:
Faculty Contact Name:
Position/Curriculum Area:
High School:
Principal:
Address:
Phone: Fax:
STUDENT CONTACTS FOR THE PROJECT:
Student Contact: E-mail address:
Student Contact: E-mail address:
WHICH CATEGORY BEST DESCRIBES YOUR SCHOOL?
Please check one:UrbanSuburbanRural
Please check one:PublicPrivateParochial
Please checkall that apply:This project fit with existing curriculum.
Please explain:
This project addressed existing school content standards.
Please explain:
This project required special curriculum development.
PROJECT SUPPORT
Did you receive project resources and information in a timely fashion?
Yes___No___
Did you have any difficulty accessing information?
Yes___No___
Did you have any difficulty calling or emailing Thirteen or receiving staff support?
Yes___No___
If yes, please describe:
Did you receive responses to your questions in a reasonable amount of time?
Yes___No___
If no, please describe.
PROJECT OUTCOME
How many people attended and/or participated in your HR101 project and events?
Did HR101 help your school/organization attract new community involvement or interest?
Yes___No___
Please explain:
Were you able to attract people who were new to your subject or topic area?
Yes___No___
Please describe:
Do you feel that your students have increased their knowledge/understanding of human rights issues?
Yes___No___
Please explain:
Do you feel that this knowledge will have impact on the behavior and choices of those students who participated?
Yes___No___
If no, why not?
Are you planning on conducting a post-project NEXT STEP session or are you planning on continuing your HR101 project into the next school year?
Yes___No___
If no, why not? If yes, how?
Did you discuss specific NEXT STEP ideas during your project?
Yes___No___
Which NEXT STEP ideas were of most interest to the group?
Which were of least interest to the group? Why?
Which NEXT STEP ideas will your school/organization implement?
What are your next steps in implementing this outreach?
CONTENT OF HR101
Please indicate how successful the following elements were in informing participants about issues that were focused on by your and your school.
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Forms Reports
Description of the HR101 project
Very SuccessfulNot Successful
54321
HR101 Web Site
Very SuccessfulNot Successful
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Public Television Programs and Videos
Very SuccessfulNot Successful
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Resource and Organization Lists
Very SuccessfulNot Successful
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Kick-Off Event (Teacher Portion)
Very SuccessfulNot Successful
54321
Kick-Off Event (Student Portion)
Very SuccessfulNot Successful
54321
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Forms Reports
Comments:
(For Grant Recipients)
FINAL HUMAN RIGHTS 101 PROJECT REPORT
A Final Report is required following the completion of your Human Rights 101 school project. All final reports should be in written form and if possible given in electronic format.
All final reports should include the following information.
- Completed Site Manager’s Report/Evaluation Form(evaluation form on Pages50-54 in this toolkit)
- Originals of all Event Participant Evaluations (evaluation form on Pages 48-49 in this toolkit)
- Names, addresses, and organizations represented by the attendees of your local event(s)
- Detailed description and clean copies of your event agendas
- Audio recording of disucssions (if appropriate and possible to obtain)
- Copies of any photographs taken at any project events
- Copies of all promotional materials and correspondence
- Local press clipping or articles that may be written (this includes school newpapers and community newspapers)
- An accounting of how your grant funds were spent
Please use the form below for your report and add any pages needed to fulfill the above requirements.
PROJECT CONTENT:
Indicate the human rights issues that were the focus of your HR 101 project:
1.
2.
3.
Please list the PBS programs that you used for your HR101 project:
1.
2.
3.
PROJECT DESIGN
Project Focus:
General Project Description:
Project objectives:
School or community partnership that were developed for your project:
How did you spend your grant monies?
SignatureDate
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