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* 1. First Name

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* 2. Last Name

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* 3. Preferred Email Address

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* 4. I am interested in receiving a monthly newsletter from Mouse to learn about new projects and PD opportunities.

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* 5. School District Name

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* 6. School (please spell out full name; i.e. Martin Luther King Jr. Middle School)

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* 7. What state do you teach in?

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* 8. Subject(s) Taught (select all that apply):

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* 9. Which grades do you teach? (select all that apply)

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* 10. How many years have you taught?

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* 11. What is the name of the workshop you are attending today? (Ask your facilitator if you don't know)

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* 12. Have you been to any professional development with Mouse or Code/Interactive in the past? If so, explain.

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* 13. Do you have an account on create.mouse.org? If so, what is your username?

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* 14. I have the knowledge to teach digital technologies to my students.

1 - Strongly Disagree 3 - Neither Disagree Nor Agree 5 - Strongly Agree
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i We adjusted the number you entered based on the slider’s scale.

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* 15. When teaching digital technologies, I can change my teaching style to match the needs of my students.

1 - Strongly Disagree 3 - Neither Disagree Nor Agree 5 - Strongly Agree
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i We adjusted the number you entered based on the slider’s scale.

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* 16. I see myself as a creator of technology, not just a user.

1 - Strongly Disagree 3 - Neither Disagree Nor Agree 5 - Strongly Agree
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i We adjusted the number you entered based on the slider’s scale.

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* 17. Are you scheduled to teach the content of this workshop with your students for the upcoming year?

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* 18. For this school year (or the upcoming school year), roughly how many students (during or after school) do you expect to teach this PD's content or curriculum?

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* 19. If you are teaching the content of this workshop, please select any of the ways you expect to deliver the curricula?

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* 20. What category describes you?

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* 21. Which category describes you best? 

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* 22. What is your age group?

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* 23. To your knowledge, what percentage of your school’s student body qualifies for free or reduced-price lunch?

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