DO YOU Facilitator Feedback Form

Overall Facilitator Feedback

Please rate your overall experience facilitating the DO YOU UnCurriculum on a scale of 1-5, with "1" being not at all, and "5" being exceptionally. Please use the comment space on each question if you would like to comment on a specific session of the DO YOU UnCurriculum.

This feedback will help support technical assistance provided as well as inform changes to the DO YOU UnCurriculum. All feedback is kept confidential.

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* 1. Please provide your name

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* 2. Please provide your agency name

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* 3. If you are located in Virginia, what region do you serve?

Northern Virginia

Central Virginia

Tidewater

The Valley

Southwest Virginia

Not located in Virginia

Other (please specify)

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* 4. If you are not in Virginia, what state or U.S. territory do you live?

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* 5. Do You Activity instructions were clear.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 6. The length of time indicated for each session was sufficient.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 7. UnCurriculum activities related to their stated goals.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 8. The design of the ‘zine worked well with the UnCurriculum Activities

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 9. The art materials for UnCurriculum activities were appropriate and encouraged creativity.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 10. Participants engaged in the creative process with enthusiasm.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 11. Participants showed enthusiasm about sharing their work and/or participating in the discussion.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 12. Do You sessions were implemented as planned.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

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* 13. Overall, my implementation of the Do You: UnCurriculum was successful.

Not at all (1)

Exceptionally (5)

Not at all (1)

Exceptionally (5)

Comments or concerns?

Question Title

* 1. Please provide your name

Question Title

* 2. Please provide your agency name

Question Title

* 3. If you are located in Virginia, what region do you serve?

Question Title

* 4. If you are not in Virginia, what state or U.S. territory do you live?

Question Title

* 5. Do You Activity instructions were clear.

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* 6. The length of time indicated for each session was sufficient.

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* 7. UnCurriculum activities related to their stated goals.

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* 8. The design of the ‘zine worked well with the UnCurriculum Activities

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* 9. The art materials for UnCurriculum activities were appropriate and encouraged creativity.

Question Title

* 10. Participants engaged in the creative process with enthusiasm.

Question Title

* 11. Participants showed enthusiasm about sharing their work and/or participating in the discussion.

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* 12. Do You sessions were implemented as planned.

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* 13. Overall, my implementation of the Do You: UnCurriculum was successful.

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* 14. Please provide any additional comments, questions, or concern about your experience facilitating the Do You UnCurriculum.