Transfer of Learning Worksheet

The purpose of this form is to help you plan to transfer what youíve learned today to your everyday life. Be realistic, so that the things you plan to do here can be completed and help you succeed.

  1. When I get back from this session, Iíll discuss what Iíve learned and my overall impressions of todayís programs with
  2. Person: _____________________ Place: __________________ Time: _______

    What I think Iíd most like to discuss is:




    Why I want to discuss this:



  3. Iím going to "stretch" my knowledge about this topic by reading the Policy Statement of the American Academy of Pediatrics on Media Education (available at the following web site:
  4. Iím going to try to implement part of what I learned today by:


    Iím going to discuss the results of this experience with:



  6. Other activities Iíd like to do to make sure that my learning on this topic continues beyond this event:



If you need prodding, consider signing a copy of this worksheet and sending it to another person who will serve as adviser/coach/prodder.

Signed: ________________________________________________________________

Address: _______________________________________________________________

City: ______________________________________ State: ________ Zip: ________________

Send to: