Short Series Group Datasheet (FY15)
Wisconsin SNAP-Ed/WNEP
County:
Agency name:
Agency number:
Agreement name:
Agreement number:
Educational Strategy:
Audience Type:
(same for all events in the Series)

b. Group—shorter series (2 to 4 lessons)



1. Youth, 4 – 5 years
2. Youth, 6 – 11 years
3. Youth, 12 – 17 years



4. Parents of infants/children
5. Adults w/out children
6. Senior adults
Lessons, Curriculum, Other Information:
Event
Number
(from WNEP
database)
Teaching
Event
Date
Teaching
Topic
Name(s) of WNEP Staff Person who
taught
Teaching
Time (actual #
of hours of
teaching on this
date)
(MM/DD/20YY)
Attendance
(# of participants on each date)
Males
Females
Total
Teaching topics:
a. Choosing healthful foods
b. Portion awareness
c. Grain foods/whole grains
d. Fruits
e. Vegetables
f. Fruits & Vegetables
g. Milk & other Ca-rich foods
h. Meat & beans group
i. Choosing beverages
j. Foods with less fat/solid fats
k. Foods with less added sugars
l. Foods with less salt
m. Healthful foods away from home
n. Being active/balancing activity & food intake
o. Food choices during pregnancy or
breastfeeding
p. Feeding infants (inc. breastfeeding)
q. Feeding toddlers or preschoolers
r. Feeding school age children
s. Family meal times
t. Keeping hands & surfaces clean
u. Handling & cooking food safely
v. Storing food properly
w. Determining resources for food
x. Planning & tracking food spending
y. Living within a spending plan
z. Planning meals & snacks
aa. Shopping for food
bb. Eating away from home on a budget
cc. Using gardens to improve food
security
Attach either the Demographic Self-Report forms completed by the participants or the Demographic Data by Group form completed
by the teacher or agency based on actual data.
Not Hispanic or
Latino
Race Categories
Hispanic or Latino
Not Provided/No
Response
Totals
White
Include in this
section if One
Race category
was selected
Black or African American
American Indian or Native American
Asian or Asian American
Native Hawaiian or other Pacific Islander
Include in this
section if one of
these
combinations of
2 Races was
selected
American Indian/Native American & White
Asian & White
Black & White
American Indian/Native American & Black
All other Races (or combinations)
No Race Reported
Totals
Totals in Yellow highlighted cells in Tables must be equal.
Wisconsin Nutrition Education Program • Family Living Programs • Cooperative Extension
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