PARTICIPANT SURVEY FORM

Your Workshop Name Here /Date of the Workshop Here

Your comments are essential to ensuring PLT and WILD programs and materials are as useful as possible for all educators.

I.  Workshop Information

Workshop Date: / Workshop Type:
Workshop Location: Place | City, OR / Workshop Facilitators:

II. Participant Information: c Check box if you are interested in becoming a PLT facilitator

Name: ______Email: ______

School/Organization:

Permanent Mailing Address:

City: ______County: ______State: _____ Zip:

1. Is your school a Title I school? c Yes c No

2. My position is: c Preschool Teacher c Elementary Teacher c Middle School Teacher c High School Teacher

c Administrator c Preservice/University Student c Preservice Instructor c Homeschool Educator

c Nonformal Educator (e.g. scout leader; resource professional, etc) Specific Grade-Level: ______

4. Year started teaching: No. of students reached/year: Student Demographics: c Urban c Suburban c Rural

5. In what subjects will you use PLT &WILD? c Science c Social Studies c Math c Lang. Arts c Reading

c Physical Education c Visual Arts c Performing Arts c Special Education c Other: ______

Workshop Feedback

1.  The information, strategies, and instructional methods modelled were helpful. / Not at all / Somewhat / Very much
2.  The PLT and WILD activities are relevant and useful for the audience I teach. / Not at all / Somewhat / Very much
3.  I understand how PLT and WILD activities support the academic standards I teach. / Not at all / Somewhat / Very much
4.  I will use the supplemental resources shared at the workshop / Not at all / Somewhat / Very much

Please help us understand rating and improve our program by providing further clarification of the ratings above.

Never / Several times/ yr / Weekly / As an integral part of one or more units
5.  Prior to the workshop I used PLT and/or WILD activities:
6.  After this workshop I intend to use PLT and/or WILD activities:
7.  Prior to the workshop I extended my classroom lessons into the outdoors:
8.  As a result of this workshop I intend to extend my classroom lesson(s) into the outdoors using the curricula and resources from this workshop:
9.  Prior to the workshop I used interactive strategies and activities for teaching about the about the earth’s physical, living and human systems.
10.  As a result of this workshop I intend to use interactive strategies and activities for teaching about the about the earth’s physical, living and human systems.

Please help us understand rating and improve our program by providing further clarification of the ratings above.

Additional Comments:

By providing us with your contact information you accept the practices described

in Project Learning Tree’sPrivacy Policy, a copy of which can be found at www.plt.org.