D.A.R.E. Alaska

First Name:

Last Name:

Date:

Rank:

Agency:

Location:

Choose One:

Federal (Non- Military) Military City/Borough Police Dept. State (Non-AST)

State Trooper VPSO Village Police Officer

Percent of Duty spent on D.A.R.E. :

Indicate below the number of students and schools that participated in the different curriculum.

Number of Parent Programs taught:

Number of parents that participated:

Name of Schools and Location where you taught:

School #1 ; Location #1 School #2 ; Location #2

Name of School Districts you taught in:

District #1 District #2

Has D.A.R.E. been taught in your school within the last three years?

Were any other D.A.R.E. officers teaching in the same school?

Did you teach D.A.R.E. in the school year of 2010-2011?

Do you plan to teach during the 2012-2013 school year?

If yes, what grades?