MPLA: Grant Evaluative Report Form

MPLA Professional Development Grant Evaluative Report

The Evaluative Report is due within 60 days following the conclusion of the program for which the grant was given, or before the next MPLA Annual Conference, whichever occurs first.

For information please consult the MPLA Professional Development Grants Program.

Fields noted in RED are required and must be completed for your request to be transmitted.

Your Information

Full Name:

Email:

Mailing Address:

City:

State:

Zip Code:

Business Phone:

Alternate Phone:

Current Position:

Grant Information

Grant Type Approved:

Regular Grant ($600 max) Mini Grant ($150 max)

Grant Amount Approved by Professional Development Grant Committee:

Information About the Program/Presentation

Date(s) of Presentation:

Location of Presentation:

Title or Research Description:

Program Evaulation and Budget

Briefly summarize your involvement in the program. State its relevance to your position and your overall goals. Cite positive and negative aspects of the program.

Summarize your specific objectives for the program. Indicate if you attained those objectives, and if som how they contributed to your personal growth, future goals, and career development. If you received a grade, please provide documentation of the successful completion of your program.

Comment on the quality of your experience and whether or not you would recommend this institution, program, and/or instructor to another MPLA member.

Itemize your actual expenses, noting those covered by the grant, those covered by another association or institution, and those out-of-pocket. Receipts can be mailed to MPLA executive Secretary Judy Zelenski as noted below.

For questions or comments, or to e-mail electronic copies or mail hard copies of supporting documentation, contact:

Judy Zelenski
MPLA Executive Secretary
14293 W. Center Drive
Lakewood, CO 80228
Email:mpla_execsecretary@operamail.com