1. Field Trip or In-Class Program Information

Thank you for taking the time to complete this questionnaire.

The information you share here will help you as a science education program provider as well as the Providence After School Alliance (PASA) and the Providence Public Schools to find out about field trips or short-term in-class presentations you can offer and the ways they might be aligned with Providence Public Schools core science curriculum for middle school youth.

The questionnaire will help determine how your field trip or in-class presentations match up with the science curriculum topic areas for the middle school grade levels.

As you complete the questionnaire, please note that:

* this survey is related only to MIDDLE SCHOOL science learning programs.
* the attached survey is designed for you to share information related to a SINGLE field trip or classroom presentation.
* if you have additional field trips or presentations, please complete an additional survey for each of those experiences.

Also, there are TWO ADDITIONAL questionnaires which might be of interest to you:

* one with questions about multiple-session after-school or in-school program alignment with state academic standards.
* one with questions about multiple-session after-school or in-school program alignment with Providence's middle school science curriculum.

Both of these can be accessed from a link on PASA's homepage: www.mypasa.org

If you have any questions about the questionnaire or would like to forward electronic versions of materials which you feel are essential to adequately portray your program(s), feel free to contact Patrick Duhon, Director of Expanded Learning for both PASA and PPSD, at patrick.duhon@ppsd.org.

Again, thank you for completing this questionnaire.

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* 1. Program Contact Information

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* 2. Is this program a field trip or an in-class program?

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* 3. Please provide a brief description of your program:

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* 4. Please describe your experience in providing this program (e.g., for how long? for whom? for how many youth? in what context?, etc.):

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* 5. Is this program a one-time experience or does it require multiple sessions?

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* 6. Is there a cost associated with this program and/or is the participating school required to provide any in-kind materials?

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* 7. If a field trip, do you provide transportation to and from the school?

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* 8. Would this field trip or special program be appropriate for an after-school setting?

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* 9. Additional comments or information: