PEO Presentation Report Form PEO Program Presentation Report Form Step 1 of 2 50% Presenter Name* School/Org.* Program Date* MM slash DD slash YYYY If multi-session list start dateTopic or Basic Outline Used* # Programs*Program= group of people. E.g. Teaching 5 different groups of people = 5 programs. *If entering multiple programs, be sure to multiply your number of participants and demographic data accordingly.*Is this a Multi Session Program?* Yes No Please identify your audience. Select all that apply.* One time school program Multi-session school program One time after school program Multi-session after school program One time college program Multi-session college program Faith Based community program Men's Program Eldery Program Program for people with IDD Parent Program 86it Program Bar Outreach Other Community Program Human Trafficking Other What level of prevention is this program? Primary Prevention Secondary Prevention Tertiary Prevention Audience DemographicsUnless gathered though evaluation materials or audience's disclosures, this data is based on assumptions.Total Participants* Did you collect participant demographic information?* Yes No # Males (self-reported) # Females (self-reported) # Nonbinary/Gender noncomforming (self-reported) # Youth# AdultBlack (self-reported)White (self-reported) Latinx (self-reported)Indigenous (self-reported)Asian (self-reported)Bi/Multiracial (self-reported)People w/ Disabilities (self-reported) # Disclosures* Facilitator HoursPlease add total time for all volunteers for each category and round to the nearest .50. ALL HALF HOURS MUST BE INDICATED AS .50 (EX: 1.50, 2.50, ETC.)Prep Time*Presenting Time*Travel Time*Program DescriptionProgram Assessment*What went well? What would you change? Other Comments.