YN Service Record
Event Information

Presentations
  Date(s) of Event:
       
  Number of Participants Start & Finish Time Prep./Wrap Time
Estimate
Actual
       

Purpose of Service
Health Fair
Program Promotion
M.I./ M.H. Weeks
Class/School Curriculum
Other
       

Location
Name (bldg./complex)
Street Address, Unit #
Intersection/Directions
Parking Information
Room Name, Number
       

Youth Net Coverage
Staff
Students
Volunteer(s)
       

 Youth Net
 Stress
 Mental Illness #1
 Mental Illness #2
 Mental Illness #3
 Mental Illness #4
 Mental Illness #5
 Youth Friendly
 
Other (please list)
 

Discussions
 Pens & Paints
 Focus Groups
 Developmental
      Assets
 

Awareness
 Health Fair
 Display
 Event
 
Other (please list)
 
 
 
Client Information
Host:
Contact:

Title:

Phone:

Department:

Cell:

Fax:

Street:    
City:

Province:

Postal Code:

Email
Notes:
   
Client Information

Audience

Physical Environment
 Youth
dress code
staff on-call?
room size
room setup
   

Learning Tools
Item Yes No On-Site Bring Other
O/H Proj'tr
Screen
White Brd.
VCR
Laptop
LCD
Flip Chart
Hand-outs
   

Learning Objective

   

Other

 Student - College
 Students - High
      School
 Students - Senoir
        Public
 Volunteers
 Employees/Staff
 Management
 Committee
 General Public
 

Participants
 chose the topic
 mandated to
      attend
 recent
      experience
 unaware of
      agenda
 
 
 
 
 
 
 
 
 
 
   
 

 

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