SAGE TEAM DATA SHEET

As part of our assessment efforts, starting in 2007, we will ask that each participating SAGE teacher to complete the following questionnaire.

Country: __________________________ Number of Years in SAGE: ______

Please mark the following as they apply to your high school:

SAGE is part of an existing class?  Yes  No

SAGE is an extracurricular activity only?  Yes  No

SAGE is open to all students in your school?  Yes  No

Please enter a number for each of the following:

Number of Faculty involved: _______Number of Active students involved with projects: _______

Number of BAB Members: ________ Total hours of involvement by BAB Members: _______

Number of University/College Mentors: _____Total hrs of involvement by University Mentors: _____

Estimated number of new business ventures started by the SAGE team?____

How many of these will likely continue next year?_____

Estimated number of continuing business ventures operated by the SAGE team?____

How many of these will likely continue next year?_____

Estimated number of new social ventures started by the SAGE team?____

How many of these will likely continue next year?_____

Estimated number of continuing social ventures operated by the SAGE team?____

How many of these will likely continue next year?_____

Estimated number of school age (5-13) children reached by all SAGE projects: ________

Estimated number of senior citizens (65 or older) reached directly by all SAGE projects: ________

Estimated number of community citizens reached by SAGE projects: ________

Mass Media:

Estimated total number of individuals reached through mass media (this counts a person only once, no matter how many times that person was reached): ______

Amount of SAGE funds raised through:

(1) SAGE Operated Businesses: $________

(2) Grants received: $________

(3) Donations received (e.g., fundraisers): $________

(4) Other: ___________________ $________

Please list the following:

1. The names of high school organizations affiliated with SAGE:

 

2. The names of community organizations involved with projects:

 

3. International countries your team worked with:

 

I verify the information on this form is correct:

 

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Signature of SAGE Faculty Advisor

 

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Printed Name of SAGE Faculty Advisor

 

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Email Address of SAGE Faculty Advisor

 

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Web site of SAGE Team (if applicable)