Educational Program Survey

Type of program / materials utilized

Grade level of students

Length of program (how long were were in your classroom / on campus)?

Which programs and/or materials did you utilize? Check all that apply.

Did the presentation/materials hold the attention of the group?

Yes

No

Comment

Were the presentation(s)/materials grade appropriate?

Yes

No

Comment

Did any part of the program address one or more of the California state life science standards, Education and the Environment Initiative (EEI) and/or Common Core Standards for the grade level you teach?

Yes

No

Comment

How important are addressing educational standards to you/your school or agency? (1=lowest, 5=highest importance)

Comment

Would you recommend the program, presentation and/or materials to other teachers?

Yes

No

Comment

We would like to assess whether our programs actually result in a change in behavior which reduces the number of mosquitoes growing in yards and neighborhoods. Would you be willing to aid us in that assessment by sending home to families of students who have participated in one of our programs a preprinted, short survey we provide to you?

Yes

No

Comment

Name (optional)

School/Agency (optional)

Email (optional)

Phone (optional)

May we contact you?

Yes, please contact me

No need to contact me

Additional comments?