Reimbursement/Evaluation Form Spring semester grant receipts – submit form by January 31, 2022 in order to be reimbursed. Name* First Last School Name* School Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School Phone* School Email* Confirm School Email* Make check out to:* Number of Students helped by grant* Total $$$ of receipts* Copies of receipts for potatoes purchased*File uploads may not work on mobile devices. Upload PDF documents only. Funds will not be provided without copies of receipts for potatoes purchased. Drop files here or Select files Accepted file types: pdf, Max. file size: 256 MB. Teacher EvaluationInstructor Name* First Last Type of potatoes used?*List of ways in which potatoes were prepared?*In your unit, did you address Potato Variety?* Yes No In your unit, did you address Potato Nutrition?* Yes No In your unit, did you address Agriculture Industry Careers?* Yes No Please check the provided materials you utilized in your potato units:* Recipe Demonstration Nutritional Powerpoint Presentor in Classroom Please let us know you like about this program or what we can do to improve to fulfill your needs*What type of additional resources would be useful to your classroom in the future?*Comments: Please share your experience, comments and suggestions for this program*Please upload any images you might have from your classroom's use of the Potatoes in the Classroom grant or resourcesFile uploads may not work on some mobile devices. JPG, PNG, or PDF only. Drop files here or Select files Accepted file types: jpg, png, heic, pdf, jpeg, Max. file size: 256 MB.