STATEWIDE PARENT ADVOCACY NETWORK, INC. (SPAN)

ACTIVITY/ EVENT REPORT

SPAN Staff:________________________ Date of Activity: ____________________

Total Staff Time Spent: _______________

Contact Person/Organization _____________________________Phone: ( __ ) _____________

Location of Activity ________________________________________ Urban?______________

NATURE OF ACTIVITY/EVENT:

____Training ____Presentation ____Meeting ____Conference

____Consultation w/parent ____School meeting:_____ ____Hearing/due process

____Resource Development ____Task force/committee ____Other:______________

PARTICIPANTS: Number of each type/category

____Parents ----------------	____Children w/o disabilities	____Children w/disabilities
____Educators -------------	____General educators	____Special educators
____School Administrators	____District Administrators	____ State/Fed. Administrators
____Students	____Medical/professional	____CST member

____Other personnel from child-serving agencies (Specify:_____________________________)

____Underserved (Specify:_______________________________________________________)

MATERIALS DISTRIBUTED/HANDOUTS: Number of each

___Brochures ___Manuals ___Info packets ___Other:________________________

Description of Activity/Event: Purpose, Format, SPAN’s Role, Outcomes, etc.

Follow-Up/Next Steps:

pUse Back or Attach Additional Page, if necessary.