ServiceNation Day of Action- Evaluation Form

Thank you for hosting or participating in a ServiceNation Day of Action project on behalf of AmeriCorps Alums. As part of the effort to track the impact of AmeriCorps Alums across the country, we ask that you complete the below evaluation form.

To upload photos and video footage, from your Day of Action Event, visit www.americorpsalums.snapfish.com/snapfish

First Name *First Name		Last NameLast Name
Day of Action City/State *Please provide the city and state where your Day of Action event took place (City, ST)
Signatures Gathered *The number of signatures gathered for the ServiceNation Declaration of Service on the Day of Action was:		Alumni participants *The number of AmeriCorps alums who were present at the event was:
AmeriCorps member participants *The number of current AmeriCorps members who were present at the event was:		Other participants *The number of other participants (excluding AmeriCorps alumni and current AmeriCorps members) that were present at the event was:
People Engaged *The number of people engaged (an engaged person includes any person that participants talked about service with during the Day of Action) at your Day of Action event was:
Elected officials *The number of elected officials that attended the event was:
Media ParticipationIf applicable, please list the media company and contact information for any media that attended the event
QuoteIf applicable, please provide us at least three great one-sentence quotes about the impact of service that were shared during your event. These can be from alumni stories or event participants.

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