Form DEA-316A Activity Report

OMB No. 1117-

US Department of Justice Drug Enforcement Administration Red Ribbon Week Patch Activity Report

EXP DATE:

This form certifies your completion of all program requirements and MUST be completed to receive your

DEA Red Ribbon Week Patches.

Scout unit or troop number: _________ Council Name: _____________________________________

Troop’s mailing address (print): ________________________________________________________

City: _________________________________ State: ________________________ Zip Code _______

Troop’s e-mail address (Print): _________________________________________________________

Number of Boy Scouts or Girl Scouts that attended the anti-drug prevention session: ______________

Number of Boy Scouts or Girl Scouts that took the drug free pledge: ___________________________

Number of patches requested for your troop or unit: ________________________________________

Please describe the Red Ribbon Week activity/event your troop or unit sponsored:

Approximately how many participants attended your Red Ribbon Week activity? _________________

Did you partner with anyone? Yes ____ No ____

If so, please mark all that apply:

Please mark as appropriate:

________Business/Corporation ________Civic organization/non-profit

________School ________Faith-based organization

________Government Agency ________Coalition

(city, county, state, or federal) ________Other ___________________

Please describe the anti-drug prevention education session attended by the scouts (i.e. discussion, lecture, etc):

Are you planning to participate in next year’s Red Ribbon Week? Yes ____ No ____

Is there anything that you recommend to improve DEA’s Red Ribbon Week Patch program for next year?

DEA-316A