Reimbursement/Evaluation Form

Second semester grant receipts must be submitted by May 1, 2026 in order to be reimbursed.

Teacher Name*
First Last
School Name*
School Address*
Street Address Address Line 2 City State ZIP Code
School Phone*
Teacher Email Address*
Confirm Teacher Email Address*
Make check payable to:*
Number of students helped by grant*
Total dollar amount of potatoes purchased (POTATO PURCHASES MUST BE HIGHLIGHTED OR CIRCLED ON YOUR RECEIPTS)*
Copies of receipts for Wisconsin 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

Accepted file types: pdf, Max. file size: 256 MB.
Teacher Evaluation
Instructor Name*
First Last
List types 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
- Presenter in Classroom
Please let us know you like about this program or what we can do to improve.*
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 Wisconsin Potatoes in the Classroom grant or resources.
File uploads may not work on some mobile devices. JPG, PNG, or PDF only.
Drop files here or

Accepted file types: jpg, png, heic, pdf, jpeg, Max. file size: 256 MB.

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Reimbursement/Evaluation Form

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