Challenge Report Back Form

REPORT BACK FORM
Directions: We want to hear your results!! After you finished your 5 Challenge Projects, please complete this form
and mail it back to us. Once we receive this form, we’ll be sure to recognize you for your great effort! Feel free to
use additional paper or include attachments such as newspaper clippings, photos, etc.
First Name: Last Name:
Address:
City: State: Zip:
Phone Number: School Name:
Birthday: Email Address:
PROMISE What project did you complete? How many people volunteered to help with this project?
1
Caring
Adults

Absolutely Incredible Kid Day
Big Brothers Big Sisters
Family Volunteer Day
How many kids were provided with a Caring Adult as a result of
this project?
Thank Your Mentor Day
Other: ___________________________
Tell us about it!

What was the most successful part of your What would you change about your project if What did you learn by completing this project?
project? you were to do it again?
2Safe
Places

Lights On Afterschool
Advocate for Play
i-MENTOR Program
Youth Traffic Saftey Month
How many kids were provided with a Safe Place as a result of
this project?
Other: ___________________________
Tell us about it!

REPORT BACK FORM, CONTINUED
3
Healthy
Start

March of Dimes WalkAmerica
Host a Health Fair
Positive Choice Program
Prevent Teen Pregnancy
How many kids were provided with a Healthy Start as a result of
this project?
Other: ___________________________
Tell us about it!

4
Effective
Education

Common Cents
Groundhog Job Shadow Day
Semester of Service
How many kids were provided with an Effective Education as a
result of this project?
Destination Imagination, Inc.
Other: ___________________________
Tell us about it!

5
Opportunities Global Youth Service Day
to Help Others Kids Care Clubs

Presidents Volunteer Service Awards
Red Kettle Collections
How many kids were provided with an Opportunity to Help Others as
a result of this project?
Other: ____________________________
Tell us about it!

Once completed return this form either... by mail: by email: by fax:

America’s Promise Alliance YouthPromise@americaspromise.org 703.535.3903
Attn: Katie Peters
909 N. Washington Street, Suite 400
Alexandria, VA 22314-1556

Challenge Report Back Form

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REPORT BACK FORM

First Name: Last Name:

City: State: Zip:

Phone Number: School Name:

Birthday: Email Address:

Tell us about it!

Tell us about it!

Tell us about it!

Tell us about it!

Tell us about it!

Once completed return this form either... by mail: by email: by fax:

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