NEPTL ACTIVITY LOG: 1/
Please use this log to document the following events and activities—outside of the classroom, including Family Health Events (Nutrition Night, Health Fair, parent/caregiver workshop…); Nutrition or Physical Activity Health Awareness Month activities; Staff Professional Development; Youth Empowerment.
NEPTL Name: ______School: ______
Date: ______Date/s of Activity: ______
With whom did you collaborate to coordinate this event? (Check all that Apply)
¨ Teachers / ¨ Site Nutrition Coordinator / ¨ Principal¨ Students / ¨ Parents/Caregivers / ¨ Parent Liaison
¨ CBO ______
¨ Other (Please Describe):
______/ ¨ School Nurse or LSC)
¨ Learning Support Professional (LSP) / ¨ Health Advocate
¨ Other NEPTL/s
Briefly describe the method of event implementation by checking all applicable box(es) and commenting below.
¨ Assembly / ¨ After-School Program Activity / ¨ Family Health Event¨ Curriculum/Lesson distribution / ¨ Bulletin Board Display / ¨ Central workshop presentation
¨ Workshop/presentation site for staff / ¨ Other (please specify) ______
£ Youth Empowerment Activity
Length of activity (workshop, event…) ______
Description:
Identify the method(s) used to inform and publicize to students, staff or parents by checking all applicable box(es) below.
¨ School Newsletter / ¨ Assembly / ¨ Daily Bulletin¨ Bulletin Board / Posters / ¨ Individual Referral / ¨ Classroom Presentation
¨ Parent Meeting (PTA, etc.) ¨ Staff Meeting Presentation ¨ Grade Level Presentation
¨ Parent letter ¨ Other (Please Describe): ______
Approximately how many students participated in this activity? ______Staff? ______Parents? ______
Describe the impact this event had on students’ knowledge and behavior:
Please describe your tasks & responsibilities related to this event:
(over)
NEPTL ACTIVITY LOG… 2/
Please complete the following chart indicating successes (+) and changes that might be made (D) when planning the activity in the future.
+ / DPlease bring completed form to the next NEPTL meeting.