PPQ

Pre-Program Questionnaire

At least two weeks prior to Jeff Yalden’s visit, please take a little time to fill out this form in order to provide a meaningful, memorable event.
What is the name of the organization hosting the event?
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If your event covers more than one day, please enter the LAST day.
Who will be in the audience? (Check all that apply)
If you answered "other", please describe who will be in the audience.
Please enter the approximate number of people expected in the audience.
Please provide the name of the venue (ie - school, convention center, etc).
What venue will be used for the event?
If you answered "other", please describe what type of venue will be used for the event.
Please provide the physical address of the event venue for GPS purposes.
Who will be Jeff Yalden's main contact during his visit? If YOU are the main contact, you do not have to populate this field.
Please provide the title of the main contact (ie - parent, counselor, teacher, assistant principal, etc).
If YOU are the main contact, you do not have to populate this field.
Please provide the cell phone number of the main contact.
Please provide the name of the school principal or event supervisor (if applicable).
Please provide the principal's or supervisor's email.
Please provide the principal's or supervisor's phone number.
What is the main theme of your event? What topic(s) should Jeff Yalden address?
Are there any current challenges/problems about which the community is concerned? If so, please describe above.
Are there any current achievements about which the community is proud? If so, please describe above.
Please include any other relevant information that you would like to share.
Click or drag a file to this area to upload.
Please upload any documents you have regarding the event (if applicable).