PART 1

Description of Event

1) Name of Event-

2) Problem Identification - Describe the problem; use available local data relevant to the event to be held. Include the source of the data. (No more than 1000 characters)

3) Event Description- Describe the purpose of the event, where it will be held, the target audience, potential reach, and how it will help Wyoming meet the Core Performance Measures listed in the cover letter. (No more than 1000 characters)

4) Objectives – Describe the objective of the event. (No more than 4000 characters)

5) Event Evaluation –Describe how you will evaluate the event as it relates to your objective. Evaluation should answer the who, what, when, where, why, and how of your objective. Use actual numbers to demonstrate safety improvement. (NOTE: you must include an evaluation on each event) (No more than 3000 characters)

PART 2

Proposed Cost Schedule for Events

Name of Event:

Personnel Costs:

Position One	Title:
Hours	Cost Per Hr	Total Cost	Notes:
Planning/ Meetings	$0.00
Recruitment	$0.00
Development of Content	$0.00
Travel	$0.00
Set Up	$0.00
Actual Event	$0.00
Debrief	$0.00
Reporting	$0.00
Total Position One	$0.00

Position Two	Title: a
Hours	Cost Per Hr	Total Cost	Notes:
Planning/ Meetings	$0.00
Recruitment	$0.00
Development of Content	$0.00
Travel	$0.00
Set Up	$0.00
Actual Event	$0.00
Debrief	$0.00
Reporting	$0.00
Total Position Two	$0.00

Position Three	Title:
Hours	Cost Per Hr	Total Cost	Notes:
Planning/ Meetings	$0.00
Recruitment	$0.00
Development of Content	$0.00
Travel	$0.00
Set Up	$0.00
Actual Event	$0.00
Debrief	$0.00
Reporting	$0.00
Total Position Three	$0.00

Total Personnel Costs	$0.00

Proposed Cost Schedule for Events Continued

Cost of Venue:

Travel Costs:

Cost Per Mile	# of Miles	Total Mileage
Mileage	$0.00

Cost Per Day	# of Days	Total M&IE
Per Diem/ Meals (M&IE)	$0.00

Cost Per Day	# of Days	Total Hotel
Hotel	$0.00

Total Travel Cost	$0.00

Materials (Please List):	Cost:	Notes:

Total Materials	$0.00

Media (Please List):	Cost:	Notes:

Total Media	$0.00

Other/Misc (Be Specific):	Cost:	Notes:

Total Other/Misc	$0.00
Total Cost for Event	$0.00

** PLEASE VERIFY YOUR TOTALS AND DOUBLE CHECK YOUR NUMBERS.