Series Group Datasheet (FY16)
Wisconsin SNAP-Ed/WNEP
County:
Agency name:
Agency number:
Agreement name:
Agreement number:
Educational
Strategy:
Audience Type:
 Group—longer series (5 to 8 lessons)
 Group—shorter series (2 to 4 lessons)
 1. Youth, 4 – 5 years (max. of 2 lessons)
 2. Youth, 6 – 11 years
Event
Number
Teaching
Event Date
(from WNEP
database)
(MM/DD/20YY)
Teaching
Topic
Number of lessons in series for this group:
 3. Youth, 12 – 17 years
 4. Parents of infants/children
Name(s) of WNEP Staff Person
who taught
 5. Adults w/out children
 6. Senior adults
Teaching Time
Attendance
(actual number of
hours of WNEP
teaching on this date)
(# of participants on each date)
Males
Females
Total
Teaching topics:
a. Choosing healthful foods
b. Portion awareness
c. Grain foods/whole grains
d. Fruits & Vegetables
e. Milk & other Calcium-rich foods
f. Protein foods
g. Choosing beverages
h. Foods with less fat/solid fats
i. Foods with less added sugars
j. Foods with less salt
k. Healthful foods away from home
l. Being active/balancing activity & food intake
m. Food choices during pregnancy
n. Feeding infants
o. Feeding children
p. Family meal times
q. Handling & storing food safely
r. Planning & tracking food spending
s. Planning meals & snacks
t. Shopping for food
u. Using garden produce
It is expected and recommended that the Ethnicity and Race of group participants be collected during the first lesson of the series.
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
Include in this
section if One
Race category
was selected
Hispanic or
Latino
Not
Provided/No
Response
Totals
White
Black or African American
American Indian/Native American/Native Alaskan
Asian or Asian American (Hmong, Japanese,
Chinese, Filipino, Korean, Vietnamese, and others)
Native Hawaiian or other Pacific Islander
Include in this
section if a
combination 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
NOTE: Totals in Yellow highlighted cells in Tables must be equal.
Wisconsin Nutrition Education Program • Family Living Programs • Cooperative Extension
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