Aquatic Resources Education Program – Demographic Data Form

Please fill out this data form to the best of your ability by typing right into the form and saving it. These figures are used by the MD Department of Natural Resources Aquatic Resources Education Program when applying for federal funding, grants, and other funding.

Today’s Date: Click here to enter text.	Date of Event: Click here to enter text.
Your Name: Click here to enter text.	County: Click here to enter text.
School/Organization: Click here to enter text.
Complete Street Address: Click here to enter text.
City: Click here to enter text.	State: Click here to enter text.	Zip Code: Click here to enter text.
Name of Program (Please check one only):
Aquatic Resources Educ. Grant	☐	Climate Change 101 Workshop	☐	STEM School Event	☐
Project WET Workshop	☐	Invasive Species Workshop	☐	Envirothon Training	☐
Getting Little Feet WET Workshop	☐	Sunfish & Students Program	☐	Hooked on Fishing Day Program	☐
WOW! Workshop	☐	Trout in the Classroom Program	☐	Adult Fishing Training	☐
Marine Debris Workshop	☐	TIC Release Event	☐	After School Fishing Prog	☐
Public Special Event	☐	Classroom Program	☐	Other:Click here to enter text.	☐
Length of program in hours:	Click here to enter text.
Demographic Data for students/participants being reached through this program/training/workshop. Please DO NOT ask participants their nationality, this is just an eyeball glance/estimate.
Number of Males	Click here to enter text.	Number of Black	Click here to enter text.
Number of Females	Click here to enter text.	Number of Latino or Hispanic	Click here to enter text.
Total Number of Students	Click here to enter text.	Number of Asian	Click here to enter text.
Number of participants with special needs.	Click here to enter text.	Number of Native Amer. Or Alaska Native	Click here to enter text.
Number of Volunteers/Parent Helpers	Click here to enter text.	Number of Native Hawaiian or Pacific Islander	Click here to enter text.
Percentage of Students on Free or Reduces Lunches (School-wide)	Click here to enter text.	Number of White	Click here to enter text.
Number of Mixed	Click here to enter text.

Please return by emailing completed form within a week of your program to Chelsea.Miller@maryland.gov

Etgen, Cindy

2021-03-02

Anthony Burrows

Maryland Department of Natural Resources