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Program Evaluation Form

2. Branch*
   -- Select One --Administration/Support ServicesAtkinsBelcher-WycheBlanchardBoard of ControlBookmobileBroadmoorCedar Grove/Line AvenueDavid RainesGilliamHamilton/South CaddoHigginbotham-BrysonHollywoodHosstonMeansMainMooretownMooringsportNorth CaddoNorth ShreveportOil CityRodessaSubstituteWalletteWest Shreveport

   Select your "Home" branch, or appropriate designation.

3. Program Provider's Name *

4. Date of program
   Date of program

   Date of program

6. Title of program

7. Was this program in house or outreach
   -- Select One --In house Outreach

8. What was the location of the outreach program?

9. Target Audience
   -- Select One --Children Teen FamilyAdult

11. select sub group

    1. Babies and Toddlers
    2. Pre-schoolers
    3. Readers
    4. All children under 10 years

12. Is this a recurring (weekly or monthly) or special programming?
    -- Select One --RecurringSpecial

14. Were any supplies used for this program?
    -- Select One --YesNo

15. How did you obtain supplies?

    1. Shopping with Area Manager (credit card)
    2. Office Supplies
    3. Petty Cash (personal expense to be reimbursed)
    4. a combination of the above

16. Petty cash expense

17. Please upload scans of receipts.

19. Please list the date of Shopping trip
    Please list the date of Shopping trip

21. Were there refreshments purchased or donated for this program?
    -- Select One --No Refreshments Purchased refreshments Donated refreshments

22. How were the refreshments purchased?

    1. Shopping trip with Area Manager (SML Credit Card)
    2. Petty Cash (personal shopping to be reimbursed)
    3. Friends Donation

23. Refreshments Expense

24. Please select date of shopping trip
    Please select date of shopping trip

26. Please upload scan of receipts.

27. Was there a guest performer or speaker for this program?
    -- Select One --YesNo

28. Speaker expense

30. Total expense

31. Total attendance*

32. Event Type
    -- Select One --Advisory Group Book Club Book Discussion/ Literary Reading Book Talk Building/ Exhibit TourClass/ Workshop Demonstration/ ExperimentsField Trip/ School Visit Film/Video Screening Hands on Arts and Crafts Games/ Gaming Interactive Games/Activity- (Trivia, Role-play, Cosplay) Lecture/ Panel Discussion MakerNetworkingsocial GatheringPerfomanceSpecial Event/ Open House/ Kickoff/FinaleStorytime- Read Aloud (includes lap sit)

33. Topic
    -- Select One --Anime/ manga /ComicsArt/ Fine Art/ PhotographyArt / CraftsArt/ Performance (Dance, Magic, Music,Puppetry, theatre) BusinessCareer / ResumeCommunity Interest Computers- Code, Programming , RepairCreative Tech/ Media ProductionEducation/ Test Prep/ College PrepFinance/ Personal FinanceFoodGaming (board, cards) Gaming (computer, video) GEDGenealogyGeneral StorytimeHealth and wellnessLanguage LabMakerPop CultureSTEAM (Science, Tech, Engineering, Art, Math)

35. Evaluation

    1. This program should not be provided again at this branch.
    2. This program had potential, but should be redesigned.
    3. This program was useful and well received.
    4. This was a great program as a special event and should be considered for annual programming.
    5. This program should be a recurring program that is shared with other branches.

36. Please explain you evaluation of the program. Please provide details about patron reaction and feed back.

38. Who is your Branch Manager or Department Head?
    -- Select One --Atkins (Tenisha Edwards)Belcher-Wyche (Lesa Miller)Blanchard (Grace Harr) Broadmoor (Ariel Stewart)Broadmoor YS (Mary Phan)Cedar Grove-Line Ave (Maureen Fitz-Gerald)David Raines (Sharon Samuel-Wade)Gilliam (Carrie Nichols-Tucker)Hamilton-South Caddo (Hanna Hoang) Hamilton-South Caddo YS (Jackquenline Sudds)Higginbotham-Bryson (Cathy Key) Hollywood-Union Avenue (Pamela White) Hosston (Mindi Broussard)Main (Chris Kirkley) Main YS (Kayla McDonald)Means (Lois Carter)Mobile Library (Linda Byrd)Mooretown (Rose Davis) Mooringsport (Angela Childress)North Caddo (Bernice Bradshaw)North Shreveport (Ranee Terry)Oil City (Sherri Baca) Rodessa (Laura Carroll) Wallette (Wyolanda Hall) West Shreveport (Sheryll Anderson)Programming/Outreach (Lauren Metzger)

    Department Head is only available for Youth Services departments at Resource Centers and Adult Literacy at this time.

40. Who is your Area Manager?*
    -- Select One --Mary CanfieldJenifer FrenchJeff ImpsonLauren Metzger

41. Please upload additional materials.

    Please attach any supporting materials including pictures.

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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