ITVS: Outreach Evaluation Form for Community Partners

Outreach Evaluation Form for Community Partners

Thank you again for partnering with ITVS Community on our outreach campaign. Please fill out and submit this evaluation form so we can improve upon our partnership with organizations and better understand the impact our programs have on communities.

* indicates required fields

First Name*	Last Name*
Organization*
Address*
City*	State*	Zip*
Phone*
Fax
Email*
Website

Show Title: *

Date/ Time of activity:

Location of the activity:

How many people attended?

Please click on the boxes that best describe the demographics of your organization's constituency. (Choose up to 3)

What is your organization's mission? (limit-50 words)

1. Please rate the overall success of your outreach activity.

Excellent Very Good Average Poor

Comments:

2. How did participating in this outreach activity serve your organization's mission?

3. What outreach activities were you involved in? How would you rate their success?

ACTIVITY	QUALITY RATING
Public screening
Organization/Member screening
Mailing
Guest Panelists
Filmmaker attendance
Training/Workshop
Facilitated discussion
Other

Please share details:

4. What supplemental ITVS materials did you use to support your activities? Please rate the quality and usefulness of these materials.

RESOURCES	QUANTITY	QUALITY RATING
Video
Tune-in postcards
Flier
Discussion Guide
ITVS Website
Teacher's Curricula

Comments:

5. What were the outcomes? (Choose all that apply.)

New community partnerships
New members
Internal organizational development and education
Continued use of film for advocacy and public education
Developed action steps (for education or advocacy)
Press coverage
Other:

Help us share your story by providing a compelling anecdote:

6. Please identify and rate the assistance that ITVS provided.

ASSISTANCE	QUALITY RATING
developed partnerships
identified resources (not financial)
assisted with mailings
supplied outreach materials
Other
provided financial support

Please specify financial support:

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