Event Date(s) (mm/dd/yyyy):

Number Of Days:

Average Hours per Day:

Total Program Hours:

Event Time(s):

Event Location:

Facilitators/Presenters (separate names with commas):

Total Number of OWP@TC Facilitators:

Audience Type (please check all that apply and indicate numbers):
OWP@WU Teacher Consultants (not facilitating)
K-12 Teachers:

For teachers of grades... (please check all that apply)
Pre K	2	5	8	11
K	3	6	9	12
1	4	7	10

Higher Education Teachers:
Pre-service Teachers:
Other Educators::
Parents:
Students:
Others:
Total Number of Participants:

* Note: Please be sure to email a complete Participant List (including full names, current emails, and school work site for each teacher or administrator who attended any of the inservice sessions - regardless if they received credit) to the Inservice Coordinator. Thank you!

Total Contact Hours:
(Total Program Hours multipled by the Total Number of Participants)

Description of/Agenda for the Event (please add additional pages if necessary):

Primary Goal of the Event:

Program successes and suggestions for future events:

Was this activity connected to an OWP@WU partner site? Yes   No
If Yes, please name partner site and contact person:

Did this program include content focusing on the use of technology for the teaching of writing? Yes   No

Was this activity designed to have all participants attend the entire program? Yes   No

If not, please indicate:
Average Number of Days Per Particpant:
Average Hours per Day per Particpant:
Average Total Hours Per Participant

Prepared by:		Date:
Phone:	Email: