EmailMeForm
MNWT State Program Manager Visit Report
Responses to the online form will be viewed by the state program vice president. This form should be completed following a visitation as an SPM. Fill in as much information as you know. Upon completion of the form, click Submit; you will receive a confirmation screen if your form has been successfully submitted. (rev 1996)
Submitter Name
*
First
Last
Your Email
*
Programming Area
*
Please select
Community Connections
Living & Learning
Priority Area
Women's Wellness
Youth of Today
Visit Type
*
Please select
Chapter Meeting
Chapter Event
District Meeting
District Event
Other
Date of Meeting
*
MM
/
DD
/
YYYY
Place of Meeting
Mileage
*
Enter the total miles traveled one way.
Number of Members in Attendance
*
Enter the total miles traveled one way.
Number of Guests in Attendance
*
Enter the total miles traveled one way.
How far in advance where you contacted to be a speaker?
Which facet of your project area were you asked to talk about?
Visit Details
*
Yes
No
Were you welcomed and introduced?
Were the members aware of this area before your presentation?
Are they presently doing or planning to do a project in this area?
Did you use audio-visual equipment and materials?
Did you hand out materials (pamphlets, etc.)?
Were you paid for your mileage?
Did you incur any other expenses?
If so, were they paid?
Did your chapter provide you with traveling companions?
Comments, Questions or Concerns
*
Generally, explain how you feel about this visitation. Evaluation of yourself, your effectiveness and the response of those present.
Chapter/District Contact Information
District
*
Please select
District 1
District 2
District 3
District 4
District 5
District 6
District 7
District 8
District 9
District 10
District 11
Chapter
*
Other Meeting or Event
*
You chose "other" as the Visit Type; please explain what type of meeting it was.
Contact Name
*
First
Last
Contact Address
Street Address
City
State / Province / Region
Postal / Zip Code
Contact Phone
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