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Keepers in the Classroom Teacher Survey 2010-11 (GlaxoSmithKline)

1. Default Section

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* 1. Name of School

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* 2. Date of Presentation

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* 3. Total # students participating

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* 4. Grade Level for presentation (check all that apply)

Kindergarten

First

Second

Third

Fourth

Fifth

Sixth

Seventh

Eighth

Ninth

Tenth

Eleventh

Twelfth

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* 5. Student Demographics: For our reports to the NC State Environmental Education Department

Please indicate the number of students in your class that fit the following categories

Male

Female

AfricanAmerican

Caucasian

Latino

Asian

Other

Physical disabilities

Learning/emotional/mental disabilities

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* 6. Did the Keeper meet your expectations? (on-time, capture students attention)

Yes

No

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* 7. Please rate the Keeper presenter on the following:

	Excellent	Good	Fair	Poor
captured the students' attention	captured the students' attention Excellent	captured the students' attention Good	captured the students' attention Fair	captured the students' attention Poor
presented the material accurately	presented the material accurately Excellent	presented the material accurately Good	presented the material accurately Fair	presented the material accurately Poor
demonstrated knowledge of the subject	demonstrated knowledge of the subject Excellent	demonstrated knowledge of the subject Good	demonstrated knowledge of the subject Fair	demonstrated knowledge of the subject Poor
solicited questions from students	solicited questions from students Excellent	solicited questions from students Good	solicited questions from students Fair	solicited questions from students Poor

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* 8. Did the presentation parallel what was being taught in the classroom and the Standard Course of Study?

Yes

No

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* 9. Please list new ideas, facts, or concepts that were presented?

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* 10. What follow-up activities will you do as a result of this presentation?

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* 11. How could we improve this program?

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* 12. Other comments/suggestions: