BLAZES Teacher/ Chaperon Evaluation

Your input regarding BLAZES will greatly improve future planning and visits. It will only take a few minutes to complete the survey. We greatly appreciate your time and input.

1. Last Name

Last Name

2. First Name

First Name

3. Email Address

Email Address

4. School District

School District

5. Name of School

Name of School

6. Date of Visit

Date of Visit

7. I am a :

I am a : Teacher

Teacher Aide

Parent / Guardian

Other/ Chaperon

8. Please give us some feedback on our administrative process in facilitating a BLAZES visit

	Strongly Disagree	Disagree	Agree	Strongly Agree
CSEE Website is user-friendly	*Please give us some feedback on our administrative process in facilitating a BLAZES visit CSEE Website is user-friendly Strongly Disagree	CSEE Website is user-friendly Disagree	CSEE Website is user-friendly Agree	CSEE Website is user-friendly Strongly Agree
CSEE Website is informative and helpful	CSEE Website is informative and helpful Strongly Disagree	CSEE Website is informative and helpful Disagree	CSEE Website is informative and helpful Agree	CSEE Website is informative and helpful Strongly Agree
Staff responded to request in reasonable amount of time	Staff responded to request in reasonable amount of time Strongly Disagree	Staff responded to request in reasonable amount of time Disagree	Staff responded to request in reasonable amount of time Agree	Staff responded to request in reasonable amount of time Strongly Agree
Communication with CSEE staff was clear and effective	Communication with CSEE staff was clear and effective Strongly Disagree	Communication with CSEE staff was clear and effective Disagree	Communication with CSEE staff was clear and effective Agree	Communication with CSEE staff was clear and effective Strongly Agree

Feel free to comment:

9. Please rate your facilitators on the following criteria:

	Excellent	Very Good	Good	Fair	Poor
Presentation of subject matter	*Please rate your facilitators on the following criteria: Presentation of subject matter Excellent	Presentation of subject matter Very Good	Presentation of subject matter Good	Presentation of subject matter Fair	Presentation of subject matter Poor
Ability to answer students' questions	Ability to answer students' questions Excellent	Ability to answer students' questions Very Good	Ability to answer students' questions Good	Ability to answer students' questions Fair	Ability to answer students' questions Poor
Effectiveness in leading activities	Effectiveness in leading activities Excellent	Effectiveness in leading activities Very Good	Effectiveness in leading activities Good	Effectiveness in leading activities Fair	Effectiveness in leading activities Poor
Enthusiasm for activities	Enthusiasm for activities Excellent	Enthusiasm for activities Very Good	Enthusiasm for activities Good	Enthusiasm for activities Fair	Enthusiasm for activities Poor
Effectiveness in leading tour	Effectiveness in leading tour Excellent	Effectiveness in leading tour Very Good	Effectiveness in leading tour Good	Effectiveness in leading tour Fair	Effectiveness in leading tour Poor
Enthusiasm for tour	Enthusiasm for tour Excellent	Enthusiasm for tour Very Good	Enthusiasm for tour Good	Enthusiasm for tour Fair	Enthusiasm for tour Poor

Feel free to comment

10. Please rate the educational visit and its materials on the following criteria.

	Excellent	Very Good	Good	Fair	Poor
Pace of material presented	*Please rate the educational visit and its materials on the following criteria. Pace of material presented Excellent	Pace of material presented Very Good	Pace of material presented Good	Pace of material presented Fair	Pace of material presented Poor
Exercises & activities	Exercises & activities Excellent	Exercises & activities Very Good	Exercises & activities Good	Exercises & activities Fair	Exercises & activities Poor
Amount of student involvement	Amount of student involvement Excellent	Amount of student involvement Very Good	Amount of student involvement Good	Amount of student involvement Fair	Amount of student involvement Poor
Appropriate level of difficulty	Appropriate level of difficulty Excellent	Appropriate level of difficulty Very Good	Appropriate level of difficulty Good	Appropriate level of difficulty Fair	Appropriate level of difficulty Poor
Relevance to student	Relevance to student Excellent	Relevance to student Very Good	Relevance to student Good	Relevance to student Fair	Relevance to student Poor
Alignment with classroom curriculum	Alignment with classroom curriculum Excellent	Alignment with classroom curriculum Very Good	Alignment with classroom curriculum Good	Alignment with classroom curriculum Fair	Alignment with classroom curriculum Poor

Other (please specify)

11. Please rate the following activities:

	Extremely Valuable	Valuable	Slightly Valuable	Not Valuable	N/A
The periodic table and metal blocks	*Please rate the following activities: The periodic table and metal blocks Extremely Valuable	The periodic table and metal blocks Valuable	The periodic table and metal blocks Slightly Valuable	The periodic table and metal blocks Not Valuable	The periodic table and metal blocks N/A
Electricity with the meters	Electricity with the meters Extremely Valuable	Electricity with the meters Valuable	Electricity with the meters Slightly Valuable	Electricity with the meters Not Valuable	Electricity with the meters N/A
Dry ice and the fire triangle	Dry ice and the fire triangle Extremely Valuable	Dry ice and the fire triangle Valuable	Dry ice and the fire triangle Slightly Valuable	Dry ice and the fire triangle Not Valuable	Dry ice and the fire triangle N/A
Metal bars and birthday candles	Metal bars and birthday candles Extremely Valuable	Metal bars and birthday candles Valuable	Metal bars and birthday candles Slightly Valuable	Metal bars and birthday candles Not Valuable	Metal bars and birthday candles N/A
Advanced Light Source tour	Advanced Light Source tour Extremely Valuable	Advanced Light Source tour Valuable	Advanced Light Source tour Slightly Valuable	Advanced Light Source tour Not Valuable	Advanced Light Source tour N/A
Liquid nitrogen	Liquid nitrogen Extremely Valuable	Liquid nitrogen Valuable	Liquid nitrogen Slightly Valuable	Liquid nitrogen Not Valuable	Liquid nitrogen N/A
Overall rating for visit	Overall rating for visit Extremely Valuable	Overall rating for visit Valuable	Overall rating for visit Slightly Valuable	Overall rating for visit Not Valuable	Overall rating for visit N/A

Feel free to comment

12. What did you learn during this program?

What did you learn during this program?

13. What would you like students to learn more about?

What would you like students to learn more about?

14. What would you change to improve the program?

What would you change to improve the program?

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