![](media/image1.png){width="2.875in" height="1.770138888888889in"}

+----+-------------------------+---+---------------------------------+
| 1. |                         |   |                                 |
|    |                         |   |                                 |
| ** |                         |   |                                 |
| Wh |                         |   |                                 |
| at |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
| is |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
| yo |                         |   |                                 |
| ur |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
|  c |                         |   |                                 |
| ur |                         |   |                                 |
| re |                         |   |                                 |
| nt |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
|  p |                         |   |                                 |
| os |                         |   |                                 |
| it |                         |   |                                 |
| io |                         |   |                                 |
| n( |                         |   |                                 |
| s) |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
| wi |                         |   |                                 |
| th |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
|  t |                         |   |                                 |
| he |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
|  c |                         |   |                                 |
| ha |                         |   |                                 |
| ra |                         |   |                                 |
| ct |                         |   |                                 |
| er |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
|  e |                         |   |                                 |
| du |                         |   |                                 |
| ca |                         |   |                                 |
| ti |                         |   |                                 |
| on |                         |   |                                 |
|    |                         |   |                                 |
|    |                         |   |                                 |
| gr |                         |   |                                 |
| an |                         |   |                                 |
| t? |                         |   |                                 |
| ** |                         |   |                                 |
|    |                         |   |                                 |
| *  |                         |   |                                 |
| *C |                         |   |                                 |
| he |                         |   |                                 |
| ck |                         |   |                                 |
| a  |                         |   |                                 |
| ll |                         |   |                                 |
| th |                         |   |                                 |
| at |                         |   |                                 |
| ap |                         |   |                                 |
| pl |                         |   |                                 |
| y: |                         |   |                                 |
| ** |                         |   |                                 |
+----+-------------------------+---+---------------------------------+
|    | **Project Director**    |   | > **Federal Government Staff**  |
+----+-------------------------+---+---------------------------------+
|    | **Teacher**             |   | > **State Government Staff**    |
+----+-------------------------+---+---------------------------------+
|    | **Evaluator**           |   | > **Other**                     |
+----+-------------------------+---+---------------------------------+
|    | **Researcher**          |   | > **If other, list title:**     |
+----+-------------------------+---+---------------------------------+
|    | **School Counselor**    |   |                                 |
+----+-------------------------+---+---------------------------------+

  ----------------- ---------------------------------------------------------------
  **2. Did the      
  (name of the      
  meeting) meet     
  your              
  expectations?**   

                    **Exceeded my expectations**

                    **Met my expectations**

                    **Failed to meet my expectations**
  ----------------- ---------------------------------------------------------------

+-----------------------------------------------------------------------+
| # What was the best thing about (name of the meeting)?                |
|                                                                       |
| #                                                                     |
|                                                                       |
| #                                                                     |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| # What would you most like to change about (name of the meeting)?     |
|                                                                       |
| #                                                                     |
|                                                                       |
| #                                                                     |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| # What did                                                            |
| you learn from (name of the meeting) that will help you in your work? |
|                                                                       |
| #                                                                     |
|                                                                       |
| #                                                                     |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| # What topics or typ                                                  |
| es of sessions would you like to see at future (name of the meeting)? |
+-----------------------------------------------------------------------+

+-------------------------------------+------+------+--------+--------+
| **7. To what extent were you        | **   | # S  | **Di   | **Very |
| satisfied with the following        | Very | atis | ssatis | Di     |
| sessions?**                         | Sat  | fied | fied** | ssatis |
|                                     | isfi |      |        | fied** |
|                                     | ed** |      |        |        |
+=====================================+======+======+========+========+
| **(Date of the meeting) Sessions**  |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+
| > **Session title (TBA)**           |      |      |        |        |
+-------------------------------------+------+------+--------+--------+

+----------------------------------+-------+-------+-------+--------+
|                                  | *     | #     | *     | **Very |
|                                  | *Very |  Sati | *Diss | Di     |
|                                  | S     | sfied | atisf | ssatis |
|                                  | atisf |       | ied** | fied** |
|                                  | ied** |       |       |        |
+==================================+=======+=======+=======+========+
| > **8. To what extent were you   |       |       |       |        |
| > satisfied with the hotel       |       |       |       |        |
| > (location and services)?**     |       |       |       |        |
+----------------------------------+-------+-------+-------+--------+

+-----------------------------------------------------------------------+
| # Please provide any other com                                        |
| ments that can assist us in making (name of the meeting) more useful. |
+-----------------------------------------------------------------------+

Thank you for your comments and participation.

Paperwork Burden Statement: According to the Paperwork Reduction Act of
1995, an agency is not allowed to collect information unless it displays
a valid OMB control number and no persons are required to respond to a
collection of information unless such collection displays a valid OMB
control number. The valid OMB control number for this information
collection is xxxx-xxxx. The time required to complete this information
collection is estimated to average 5 minutes per response, including the
time to review instructions, search existing data resources, gather the
data needed, and complete and review the information collection. If you
have any comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: U.S. Department of
Education, Washington, D.C. 20202-4651. If you have comments or concerns
regarding the status of your individual submission of this form, write
directly to: Office of Safe and Drug-Free Schools, U.S. Department of
Education, 400 Independence Avenue, S.W., LBJ/Room 3E247, Washington,
D.C. 20202-xxxx.