Germ City Log Form

Germ City Log Form

	Date

Presenter
Presenter's Organization
Presenter's Role/Job
Number of Assistants

Name of Location	Type of Location

	1=in-school activity 2=after-school activity 3=camp 4=fair 5=community organization 6=faith-based organization 7=other (explain)

Number of children K-2
Number of children 3rd - 6th
Number of children 7th - 9th
Number of children 10th - 12th
Number of adults

Evaluation done?	0 = no, 1= yes

Internal Use Only