AGASTYA INTERNATIONAL FOUNDATION

NO. 101,Varsav Plaza, 12 Jayamahal Main road, Bangalore 560 046, India

MOBILE LAB/ SCIENCE CENTER / LIB/ LOB/ I-MOBILE/ SCIENCE FAIR/COMMUNITY VISIT REPORT

Date : District: Vehicle No:

Visit #: Program:
Opening ___________ km
Name & address of the School :
Closing ___________ km

Class/Classes participated : Travelled __________ km

(This section need to be filled only for MOBILE LAB / SCIENCE CENTER / LIB / LOB/ I-MOBILE)

Instructors Session Class No. No. Creative Communicative Teacher’s

Name & of of Total Duration computer computer presence
Section Boys Girls activities activities

Morning

Afternoon

Morning

Afternoon

Total

Session conducted: Demo / Hands on (Tick the appropriate)

If demo tick appropriate reason: Not enough space / Not enough materials / to many children / other –specify

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No. of experiments conducted-------
List of Experiments ____
___________________________________________________________________________________________________
__________________________________________

No. of computer activities conducted

List of computer activities _________________________________________________________________________

________________________________________________________________________________________________
(This section need to be filled only for SCIENCE FAIR / CAMPS / COMMUNITY VISIT)

Date Name of the school / Program Boys Girls Young Instructor Teachers Community Drop
Boys Girls Men Women outs

(This section need to be filled only for VOLUNTEERS / VISITORS / GUESTS)

Date Name of the School / Program Volunteers Guests

Men Women Visitors

Interesting questions asked (if any):

Students Feedback:

Community member/Teachers / Head of the institution’s Feedback:

Guests / Visitors / Volunteers Feedback:

Signature of Teacher/Head Master / Official Signature of Agastya’s Instructors

Name: Instructor 1.

Contact Number Instructor 2.