| Garden Therapy Award Submission Date: |
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| Garden Club: |
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| District: |
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| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| A. PRESENTATION - 20: |
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1. Light weight folder 4 page maximum - 15 |
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2. Correct information, page 1, clear and concise - 5 |
| B. ACTIVE GARDEN THERAPY PROGRAM: |
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| Name of institution, school, etc. - 1: |
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| 2. Type of handicapped involved - 1: |
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| 3. Average number at each session -10: |
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| 4. Number of times during the year that the program was presented (aminimum of 6) - 18: |
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| 5. Number of members ACTIVELY involved in presenting programs - 5: |
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| C. TYPE OF GARDEN THERAPY PROJECTS -17: |
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Active (recipients participating) - 10:
Point for each of the following: flower arranging, horticulture, terraiums, dish gardens, bulbs, birds, nature related projects, any other. |
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| 2. Service projects, parties, etc. - 2: |
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| 3. Ingenuity and variety of projects - 5: |
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| D. EVALUATION OF PROGRAM - 28: |
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1. Letter of appreciation - 5 |
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2. Identified pictures verifying Section C - 10 |
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3. Publicity relative to program - 3 |
| 4. Status of program: |
a. Introduced in the current year -5 |
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b. Continued from previous year - 3 |
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c. Indication of continuing - 2 |
| Date the Garden Therapy Chairman should expect your Book of Evidence: |
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