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* 1. School Name

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* 2. Evaluator Name

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* 3. Evaluator's Position at School

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* 4. Field Trip/Assembly/Residency Date
(For a residency, enter any date during the program.)

Date

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* 5. Organization providing Assembly/Field Trip/Residency

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* 6. Grades attending the Field Trip/Assembly/Residency

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* 7. Total number of students attending the Field Trip/Assembly/Residency

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* 8. Total number of buses used for Field Trip

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* 9. Did the Field Trip/Assembly/Residency supplement your school curriculum?

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* 10. Bus Company Used

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* 11. Did you receive preparatory material prior to the Field Trip/Assembly/Residency?

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* 12. Did you use the preparatory material with your students beforehand?

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* 13. Will you use follow-up suggestions with your students?

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* 14. Was this your first Field Trip/Assembly/Residency with this organization?

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* 15. For how many of your students was this a first time experience?

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* 16. Please rate this Field Trip/Assembly/Residency on a scale of 1 to 5 (1=Lowest/5=Highest).

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* 17. Additional Comments

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