Street Smart Evaluation
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Your input regarding this course will greatly improve future planning and course improvements.
It will only take a few minutes to complete the survey. We greatly appreciate your time and input.
1
. What grade are you in?
What grade are you in?
9th grade
10th grade
11th grade
12th grade
college
military
2
. What school or military base did you attend the Street Smart presentation?
What school or military base did you attend the Street Smart presentation?
3
. Gender
Gender
Male
Female
4
. Race
Race
Caucasion
African American
Hispanic
Asian
Other
5
. Before you experienced a Street Smart presentation, did you always wear your seatbelt?
Before you experienced a Street Smart presentation, did you always wear your seatbelt?
Yes
No
Sometimes
6
. After experiencing the Street Smart presenation, will you start wearing your seatbelt always in any position in the vehicle?
After experiencing the Street Smart presenation, will you start wearing your seatbelt always in any position in the vehicle?
Yes always
More than usual
Never
No more than usual
7
. After experiencing the Street Smart presentation, are you convinced that everyone in the vehicle needs to have a seatbelt on?
After experiencing the Street Smart presentation, are you convinced that everyone in the vehicle needs to have a seatbelt on?
Yes
No
Not always
8
. What are some of the reasons why you don't wear your seatbelt always?
What are some of the reasons why you don't wear your seatbelt always?
I always wear my seatbelt
It's not comfortable
I just don't think about it
I feel safe with air bags alone
I have a strong vehicle and don't worry about crashes
I'm afraid I might get trapped by my seatbelt
It's not cool
Going short distance
I don't wear my seatbelt in back seat
I don't wear my seatbelt when I'm with my friends
9
. Have you ever drank alcohol and driven a vehicle?
Have you ever drank alcohol and driven a vehicle?
Yes and I'm over 21 years of age
Yes and I'm under 21 years of age
Never
10
. I find my driving to be distracting when I...
I find my driving to be distracting when I...
changing the radio station
using the phone
having a conversation
brushing hair
reading
putting on makeup
changing a cd
text messaging
eating
drinking
smoking
writing
11
. If a friend or family member was driving and was impaired, would you...
If a friend or family member was driving and was impaired, would you...
Refuse to ride with them
Ride with them and buckle your seatbelt
Ride with them and not wear your seatbelt
12
. If you were in a situation where you have been drinking alcohol and needed to get home, would you....
If you were in a situation where you have been drinking alcohol and needed to get home, would you....
Drive home yourself
Call a taxi to take you home
Call a friend to take you home
Call a parent/family member to take you home
Walk home
13
. Did you share your Street Smart presentation with any friends or family members?
Did you share your Street Smart presentation with any friends or family members?
Yes
No
Not yet
14
. If you answered yes to the above question, how many friends and family members did you share this with?
If you answered yes to the above question, how many friends and family members did you share this with?
1-3
4-6
7-10
11 or more
15
. I would probably wear my seat belt more if I knew I would be stopped by the police for not using it.
I would probably wear my seat belt more if I knew I would be stopped by the police for not using it.
Agree
Disagree
Don't know
16
. How would you rate the Street Smart presentation.
How would you rate the Street Smart presentation.
The most effective presentation I've ever seen
Very good
About the same as other similar presentations/programs
Not as good
The worst I've ever seen
17
. The delivery of the Street Smart presentation was not condescending or demeaning.
The delivery of the Street Smart presentation was not condescending or demeaning.
I agree
I disagree
Don't know
18
. Would you recommend this presentation to your peers?
Would you recommend this presentation to your peers?
Yes
No
*
19
. Please tell us where you saw the presentation.
Please tell us where you saw the presentation.
City/Town:
State/Province:
20
. Please feel free to add any comments on your Street Smart experience. Also, please send us your email address if you have a Street Smart success story!
Please feel free to add any comments on your Street Smart experience. Also, please send us your email address if you have a Street Smart success story!
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