MAX PROJECT - INDEX and COMMUNITY RESOURCE SHEET

Please complete the form below identifying the community resources you consulted for your MAX projects presentation. This information will be used to complete your project evaluation. If you have any questions, contact Judy Lewis or Stacey Brown.

Thank you.
First Name:      Last Name:

Date:       (mm/dd/yyyy)
Please index your project by subject:
Subject 1:
Subject 2:
Subject 3:
Please indicate any specific focus to your project:
Gender:
Ethnic:
if other, please specify: 
Age Group:
Setting:
if other, please specify: 
Were you exploring a
potential Selective when
 you chose this topic?
Please list the faculty you spoke with/communicated
 about your project:
     
Please indicate the community agencies (up to 4) you contacted:
Agency 1 name:
Contact person:
Phone:
Website:
How did you contact
 this agency?
(check all that apply)		   phone         visit         website      
What services does this program provide:
 (no carriage return please)

Note -- Comments will wrap.  No carriage return please.  Max size 255 characters.
Comments
 (about usefulness of information, ability
 to reach, etc.):
 
Agency 2 name:
Contact person:
Phone:
Website:
How did you contact
 this agency?
(check all that apply)		   phone         visit         website      
What services does this program provide:

Note -- Comments will wrap.  No carriage return please.  Max size 255 characters.
Comments
 (about usefulness of information, ability
 to reach, etc.):
 
Agency 3 name:
Contact person:
Phone:
Website:
How did you contact
 this agency?
(check all that apply)		   phone         visit         website      
What services does this program provide:

Note -- Comments will wrap.  No carriage return please.  Max size 255 characters.
Comments
 (about usefulness of information, ability
 to reach, etc.):
 
Agency 4 name:
Contact person:
Phone:
Website:
How did you contact
 this agency?
(check all that apply)		   phone         visit         website      
What services does this program provide:

Note -- Comments will wrap.  No carriage return please.  Max size 255 characters.
Comments
 (about usefulness of information, ability
 to reach, etc.):