Local/Regional YAB
Activity Tracking Form
Please note:
When submitting paperwork (such as sign in sheets, project logs, or receipts), please email them to Julie Hill at
jah721@pitt.edu
.
1. Name (first and last):
*
2. Email address:
*
3. Phone number:
*
4. YAB region:
*
-- Select --
SE
SC
SW
NE
NC
NW
5. Date of YAB event:
*
e.g. 01/02/2018
6. Type of event:
*
-- Select --
YAB Meeting
YAB Presentation
YAB Community Service
YAB Training
Webinar
Other
7. Title of YAB event:
*
8. Number of preparation hours:
*
-- Select --
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
9. Number of hours presenting in a YAB meeting/presentation/community service/training:
*
-- Select --
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
10. Total number of attendees:
*
11. Of total attendees, how many were youth?
*
12. Does this event require a reimbursement?
*
-- Select --
Yes
No
13. Was the sign in sheet provided to CWRC?
*
-- Select --
Yes
No
14. Audience - please provide the total number attended of all that apply from the following list:
County IL staff
Private providers
Administrators
CWRC staff
Resource parents
Judges
GAL/lawyers
Other