WiSTEM2D Data Collection Form - FHI360

Thank you for participating in Johnson & Johnson's WiSTEM²D (Women in Science, Technology, Engineering, Math, Manufacturing and Design) initiative -- a multifaceted approach that supports and inspires girls and women of all ages in their pursuit of STEM²D studies and careers.

Johnson & Johnson recognizes the importance of evaluation and data collection in measuring the impact of the WiSTEM²D Youth Programs.

For each WiSTEM²D activity or event, please answer all the questions listed below and submit the completed form.

Thank you for living the Credo and using your talent for good.

About the STEM2D Lead

Your Name*

First / Given Name Last / Sur Name

Your Role

Job Title Organization / Company

Your Email*

Johnson & Johnson Region

About the Activity or Event

Date

When did the STEM²D activity or event occur?

Location

Where did the STEM²D activity or event occur?

City State / Province / Region Country

Type

What type of STEM²D activity or event was held?

Type (Other)

Please specify the type of activity or event:

Total Number of Students Served

How many students participated?

Total Number of Female Students Served

Of the total number of students listed above, how many female students participated?

Age of Students

What was the age group of the students?

Under Age 5
Ages 5 - 10
Ages 11 - 14
Ages 15 - 18

Total Educators / Teachers Served

How many educators / teachers participated?

Instructional Level

What is the age of the students that the educators / teachers work with? Check all that apply.

Under age 5
Ages 5 - 10
Ages 11 - 14
Ages 15 - 18

Estimated Number of Students Reached

How many students with the educators / teachers impact this year? TIP! Calculate by multiplying the number of participating teachers and the number of students served per teacher.

Estimated Number of Female Students Reached

Of the number of students listed above, how many are females?

Attendees

How many people attended the event?

Attendees (Female Students)

Of the total number of attendees listed above, how many were girls or young women?

Age of Attendees (Female Students)

What are the ages of the girls or young women attending the event? Check all that apply.

Under Age 5
Ages 5 - 10
Ages 11 -14
Ages 15 - 18

Student Activity Series

Did you use, adapt, download, or share an activity(s) from the WiSTEM²D Student Activity Series, which is available at STEM2D.org?

Yes
No

Student Activity Series

Please list the name(s) of the activity(s):

Employee Engagement

Johnson & Johnson Engagement

Did Johnson & Johnson employees volunteer or participate in this activity?

Yes
No

Total Volunteers

How many Johnson & Johnson employees volunteered?

Volunteer Hours

On average, how many hours did each Johnson & Johnson employee spend volunteering? List the hours per person, e.g. 1 for 1 hour or 1.5 for 90 minutes.

Total Volunteer Hours

Note! The total number of volunteer hours is computed automatically based on the specific information previously entered.
The total number of volunteer hours for this event or activity is: