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* 1. Teacher's Last Name

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* 2. Student ID Number:

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* 3. Are you interested in following a career in any of the following categories?

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* 4. Please rate the next six (6) questions on the following scale:
      - Nothing
      - A little (something, but not much)
      -A moderate amount (I recall talking about it in class and remember some things)
      -A great deal   (I feel very informed about the topic)

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* 5. What do you know about Energy Basics (electromagnetism, simple circuits, parallel circuits, generating electricity?)

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* 6. What do you know about reducing energy use?

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* 7. What do you know about forms of energy?

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* 8. What do you know about passive heating and cooling

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* 9. What do you know about electrical energy (lighting, appliances, home energy?)

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* 10. What do you know about alternative energy (solar, wind, geothermal, etc?)

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* 11. Energy Efficiency Practices: Please check all of the options that you know about on the next two questions.

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* 12. Which of the following energy savings measures are practiced at your school? (Check all that you know about)

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* 13. Do you currently practice any of the following energy saving measures at your home? (Check all that you know about)

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* 14. There has been an energy audit or assessment performed for where I live. 

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* 15. There are solar panels where I live, or we are considering adding solar panels where I live.

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* 16. There is battery storage where I live, or we are considering adding battery storage where I live. 

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* 17. Do you know what kind of insulation is installed where you live?

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* 18. Do you recycle common items such as glass, plastic, aluminum, and paper at your home?

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* 19. Do you use reusable shopping bags rather than paper or plastic? 

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* 20. Does your home have a garden and compost?

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* 21. Please let us know about what you do to preserve the environment below:

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