Facilitator Feedback Form for the Ask Before You Act Youth Engagement Guide on Sexual Consent Communication

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This form allows facilitators to report back on their education and outreach efforts after having implemented any section of the youth engagement guide to engage youth in the community.

Please complete this form after EACH educational activity/single event conducted.

What is the name of your organization? *

Name of the educational facilitator completing this form. *

Title of the educational facilitator completing this form. *

Coordinator

Health Educator

Program Director

Program Manager

Social Worker/Counselor

School Teacher

Other:

Contact phone number for the educational facilitator completing this form. *

Contact email address for the educational facilitator completing this form. *

What kind of outreach effort are you reporting on? *

After-school programming educational session or lesson

In-school classroom educational session or lesson

Community outreach event (i.e. health fairs, town halls, conferences...)

Other:

What date was this event or activity held? *

YYYY

Was the event or activity conducted in-person or virtually? *

In-person

Virtual

What organization hosted the event/activity? *

My Organization Listed Above

Other:

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