PC-NET Evaluation

2. Meeting Evaluation

3. Neighborhood Name

4. Neighborhood #

6. Meeting Sequence
   -- Select One --Module 1: PCNET OverviewModule 2: Team DevelopmentModule 3: Gather Neighborhood SuppliesModule 4: WalkaboutModule 5: Neighborhood Response and 911/Fire SafetyNeighborhood Functional ExerciseAnnual Update

7. Number of attendees

9. Facilitator Name:

10. What went well at this meeting?

11. What difficulties (if any)?

13. Next meeting

15. Flyer

    Upload the flyer you have created with the information for the next meeting; we will use this to make copies and to send them out to you.

16. Number of flyers to send:

17. Address to send flyers to:

    Include the name, street address, city, zip code, and PO box if applicable. Allow 2-3 weeks for flyers to be sent.

19. Materials needed for next meeting

    Please list any materials you need for the next meeting, including the date you need them by and address to send them to.

20. Neighborhood Contact List

    Upload the updated neighborhood contact list; this is how we create a map.

21. Neighborhood Map

    Please list the various response sites, and any specific changes you would like added, deleted, or edited on the map.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field