Semester:  Fall  Spring Date: ______

Teacher: ______School: ______

Indicate the numberof classes in which you teach health education this semester: ______

Indicate the total number of students in health education classes this semester:

9th grade______10th grade______11th grade______12th grade______

Please indicate which curricula you taught during the 2009-2010 school year. Turn in your completed form to your Health Liaison Coordinator at the end of each semester.Completion of this form ensures compliance with State and Federal funding requirements and SFUSD policies. Thank you!

1a.Have you used ANY lessons from the Project Towards No Drug Abuse (TND) research validated curriculum?

Yes (continue with question 1b)
No (skip to question 2a)

1b. Number of lessons reached with TND curriculum:

1 – 3 Lessons / 4 – 6 Lessons / 7 – 9 Lessons / 10 – 12 Lessons

Fall Semester form is due to Health Liaison Coordinator by January 19, 2010.

Spring Semester form is due to Health Liaison Coordinator by May 12, 2010.

2009-2010

1c.How much did you reorganize or change the TND lessons from the written curriculum (e.g., change the order of activities, skip or add activities)?
Not at all / A little / A lot

Fall Semester form is due to Health Liaison Coordinator by January 19, 2010.

Spring Semester form is due to Health Liaison Coordinator by May 12, 2010.

2009-2010

2a.Have you used ANY lessons from the Positive Prevention HIV/STD Preventioncurriculum?

Yes (continue with question 2b)
No (skip to question 3a)

2b. Number of lessons taughtwith Positive Prevention curriculum:

1 – 2 Lessons / 3 -4 Lessons / 5 -6 Lessons
2c.How much did you reorganize or change the Positive Preventionlessons from the written curriculum (e.g., change the order of activities, skip or add activities)?
Not at all / A little / A lot

Fall Semester form is due to Health Liaison Coordinator by January 19, 2010.

Spring Semester form is due to Health Liaison Coordinator by May 12, 2010.

2009-2010

3a. Have you used ANY activities from the Personal and Social Skills, Level 2curriculum?

Yes (continue with question 3b)
No (skip to question 4a)

3b. Number of activities reached with Personal and Social Skills, Level 2curriculum:

Communication Activities

1 – 3 activities / 4 – 6 activities / 7 - 10 activities / More than 10 activities
Decision Making Activities:
1 – 3 activities / 4 – 6 activities / 7 - 10 activities / More than 10 activities
Goal Setting Activities:
1 – 3 activities / 4 – 6 activities / 7 - 10 activities / More than 10 activities
Stress-Management Activities:
1 – 3 activities / 4 – 6 activities / 7 - 10 activities / More than 10 activities

4a. Have you used ANY lessons from the Sexuality and Society Holttextbook supplement: Chapter Six: Diversity of Relationships, Sections 1 & 2?

Yes (continue with question 4c)
No (skip to question 5a)

4b. Number of sections taught with Sexuality and Society Holtcurriculum:

Section 1 ONLY / Section 2 ONLY / Both Sections

4c.Did you teach any other sexuality lessons?

Yes, please describe ______
No(skip to 5a)

5a. Have you used any other resources/lessons(curriculum, guest speakers, videos, etc.)?

Yes (continue with question 5b)
No
5b.Types of other health education resources used and number of students reached:(Topics could include HIV/AIDS, safety, substance use, nutrition, stress management, etc.
Resources Used(curriculum, guest speakers, videos, etc.) / Subject Area

Fall Semester form is due to Health Liaison Coordinator by January 19, 2010.

Spring Semester form is due to Health Liaison Coordinator by May 12, 2010.

2009-2010