Trip Report for Youth Groups

Trip Leader Information

First Name  

Last Name  

E-Mail Address  

Your Title  

School or Organization Information

Name of School or Organization  

Type of Organization  

Youth Org. After School

Youth Org. Summer Program

Youth Org. Outdoor/Environmental Education

Youth Org. Therapeutic

Public School K-12

Private School K-12

College or University

Other, youth worker

Other, non-youth worker

School District   In which district, or independent school, do most of your students attend school? If applicable, list multiple districts.

Free or Reduced Lunch Qualifications   Approximately what percentage of youth at your school or in your organization qualify for free or reduced lunch programs?

	<40%	40%	50%	60%	70%	80%	90%	100%
Percentage that qualify.

Trip Information

Overnight Trip?  

No

Yes (Please list the number of nights below.)

Trip Location   Name of the trail, campground, park or forest.

Number of Adult Particpants   Including the trip leader.

Additional WTA-trained Adults?   Did other WTA workshop graduates participate in your trip?

No

Yes (Please list their full name below.)

Number of Youth Particpants  

Grade Level of Youth Particpants   Select all that apply.

Elementary

Middle School

High School

Post-High School (18-25)

Challenges and Successes   Briefly describe any challenges your group faced during the trip and highlight any successes in overcoming obstacles or difficulties.

Positive Impacts   Briefly describe any general or specific outcomes from your trip. If you're able, please share quotes or anecdotes that highlight the positive impacts of the trip on youth and adult participants.

Trip Photos If you're able, please share select photos from your trip. Please ensure that you have photo release forms for all persons identified in the photos. WTA may choose to share these photos on our website, in our publications, or through our other media outlets to maintain support for this program. If you would like to share additional photos, please email them to: andrew@wta.org

Photo 1

Photo 2

Photo 3

Photo Credit Please list the appropriate photo credit, for example, "Courtesy of Seattle Public Schools".

Demographics Information

Your Race or Ethnicity   Please select the category or categories with which you most closely identify.

Alaskan Native

American Indian

Asian

Black

Latino

Pacific Islander

White

Other (If applicable, please specify below.)

Your Gender   Please select the category or categories with which you most closely identify.

Man

Woman

Transgender

Other (If applicable, please specify below.)

Your Age  

Race or Ethnicity of Adult Particpants Please provide the number of adult participants, which you believe, most closely identify with the following categories.

Alaskan Native  

American Indian  

Asian  

Black  

Latino  

Pacific Islander  

White  

Multi-Racial / Multi-Cultural  

Unknown

Other

Gender of Adult Particpants Please provide the number of adult participants, which you believe, most closely identify with the following categories.

Man  

Woman  

Transgender  

Unknown

Other

Race or Ethnicity of Youth Particpants Please provide the number of youth participants, which you believe, most closely identify with the following categories.

Alaskan Native  

American Indian  

Asian  

Black  

Latino  

Pacific Islander  

White  

Multi-Racial / Multi-Cultural  

Unknown

Other

Gender of Youth Particpants Please provide the number of youth participants, which you believe, most closely identify with the following categories.

Boy  

Girl  

Transgender  

Unknown

Other

Questions / Comments