Program Evaluation Form

Name of person submitting report:		Date:
Name of organization:
Program Title (for which you received SAF funding):
Date program was held:
Total attendance:
Attendance breakdown by category:	Penn State Altoona students Other Penn State students Faculty/Staff Community (non-PSU)
Number in attendance from your organization:
Program goals:
Were the program goals met? Why or why not?

Please provide an itemized cost breakout regarding how your funding was spent:

Publicity:

Food:

Caterer name:

Speaker/Presenter

Fee for presenter:

Lodging / Hotel: (Please include name of hotel)

Meals: (Please list all meals provided)

Travel mileage: (if reimbursed)

Transportation

Bus expenses:
Provider:

Conference Expenses

Lodging:		Hotel:
Registration expenses:
Number of students:		Cost per student:
Meals:		Travel:

Miscellaneous Expenses: (Must be itemized)

Maintenance expenses: (program setup/teardown)

NOTE: Evaluation form deadline for submission is two weeks following program completion date.