DATA TO TRACK:
Survey Point Person:____________________________________________________________
Month __________ Year______ Number of Surveys being submitted: _______
*Has the data entry been completed for local use: Y or N
*Has the data already been submitted electronically to the statewide organization: Y or N
Organization’s target goal by February 4, 2013: ________
Number of surveys organization has collected to date: ___________
Goal for next month?__________
ASSESSING THE HANDLING OF THE SURVEY PROCESS:
What went well in collecting and administering the survey?
Was there anything you or your group struggled with?
Could anything be improved?
Are you satisfied with the procedures for administering the written petition? YES
If NO explain:
Any additional comments and suggestions?