Mount Holyoke College :: Action Project Form

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Take the Lead!
Mount Holyoke College
50 College St.
South Hadley, MA 01075-1459

Phone: 413-538-3500
Fax: 413-538-2409
Email: Take the Lead!

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Action Project Form

We are eager to hear about progress on your project, as well as obstacles you faced. We hope you'll take the time to fill in the action project form and get it back to us. This form gives you the opportunity to be considered for one of our three $500 project awards. However, if you'd rather just submit a report and not be considered for an award, that's fine too. Just check the appropriate box to let us know your preference. We also want to know if you'd feel comfortable letting us publicize your project. We've included a section at the end of the form where you can let us know whether or not to publicize your work.

Note: It is not possible for you to save the action project form below and return to it later. View questions for the action project form (PDF) in advance; then fill it out online in one sitting. Or, you can mail us a hard copy. In any case, your supporting evidence will need to be mailed, faxed, or submitted online.

If you have not attended the program and are a current nominee, please do not complete this form.

*Required Fields

I. Report

1a.	Your First Name*
1b.	Your Last Name*
2a.	What was your goal? *
2b.	What did you hope to achieve? *
3.	What have you been able to achieve so far? (Don’t be shy!) *
4.	What were (are) the barriers to your success? *
5.	What strategies did you use to overcome these obstacles? *
6.	What leadership skills did you develop by working on your project? *

II. Supporting Materials

If applicable, please send supporting materials that were created for your project. Video, press releases, reports, memos, posters, photos, etc. may all be submitted. Be sure samples are clearly LABELED with YOUR NAME. Samples WILL NOT BE RETURNED. Please don’t send your only copy!

1.

Are you sending supporting materials?

Yes

No

III. Optional

The information below is not required even if you are applying for an award.

We are interested in anything else you’d like to tell us about work on your project. The questions below are things we wonder about. You may answer any or none of them. Or comment on any other aspect of your experience.

1.	How did you intend to measure the success of your project?
2.	How did you end up evaluating your project’s success?
3.	Who benefited from your project?
4a.	Did you create a plan for addressing your issue?
4b	Did you have to adjust the plan as you progressed?
5.	What was involved on your part to see the project through?
6a.	Did you get help from your MHC mentor? Yes No
6b.	Please explain.
7a.	Were any mentors (other than your MHC mentor) involved in helping you with the project? Yes No
7b	Who were they and how did they help you?
8.	How many people were involved in your project or affected by it? (Be as specific as possible, including volunteers, participants or audiences):
9.	What worked best in persuading others to help you, join your effort, or support your project?
10a.	Did you collect feedback from those involved or touched by your project? Yes No
10b.	If yes, please share some of this feedback:
11.	What did you discover about leadership through your project?
12a.	Do you have plans to continue to work on this project? Yes No
12b.	Please share these plans.
13.	Other comments:

IV. Award Information

Criteria for the awards include:

the initiative and tenacity demonstrated
the degree of difficulty of the project
the tangible results, including any endorsements or awards
the potential for affecting ongoing change
the presentation of the results.

The Action Project Report Form must be submitted online or mailed and all supporting materials postmarked and mailed no later than April 30.

V. Competition

Three $500 prizes will be awarded by Mount Holyoke College for the leading action projects submitted by the end of April. Competing for an award is voluntary. If you do not want your report submitted, please indicate your preference below.

1.	Do you want to have your project considered for an award (or not)? Yes, please consider my project for an award. No, please don’t enter my action project into the award competition.

VI. Publicity

We will work on garnering press attention for completed action projects. Please indicate your preference regarding publicity, and then, if you grant permission, complete the following questions.

Permission for Publicity:
1.	Publicize my action project using the information I've provided in this form. Yes No
News coverage to date:
2a.	Has anything been printed or aired so far on your project or your participation in Take the Lead? Yes, see details below. No, nothing so far.
2b.	If YES, please share what was covered, when it was covered and by what media outlet(s) (we also love to get newsclips in the mail!):
Privacy: If you grant permission, all information provided in this report may be used in publicity materials by Take the Lead. Therefore, if anything noted in your report is of a PERSONAL nature or is information you would like kept CONFIDENTIAL, please note this here.
3.	Notes concerning material that is personal/ confidential:
Publicity Information:
4a.	My NAME as I would like it to appear in the paper (indicate any nickname along with your formal name. For example: Sarah “Sally” Smith, if you are known as Sally.)
4b.	I am the daughter of: (list the names of your parent(s)/guardian(s) as he/she/they would like the name(s) to appear in the paper, including titles such as “Dr.” or preferences such as “Ms.”):
4c.	Name of school and its location (town and state):
4d.	Local Media: (Please list the name of local papers –daily papers and weekly papers along with any local NPR radio affiliate, local TV stations, and any publications associated with your school. Phone numbers are helpful to include, if known.)
	Papers
	Radio
	TV
	School publications

IV. Action Project Form and Supporting Documentation

For award consideration the Action Project Report Form must be submitted or mailed and all supporting materials postmarked and mailed no later than April 30 to the following:

Mail to:

Rosita Nuñez
Office of Communications
Mount Holyoke College
50 College Street
South Hadley, Mass., 01075-1459

Fax: 413-538-2691

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To contact the College, call 413-538-2000.
This page maintained by the Office of Communications. Last modified on April 7, 2008.