Question Title

* 1. Patron Name

Question Title

* 2. Email Address

Question Title

* 3. Are you a person with a disability?

Question Title

* 4. Are you a family member of a person with a disability?

Question Title

* 5. Are you a professional working with a person with a disability?

Question Title

* 6. Title/Role

Question Title

* 7. What grade level(s) do you teach? (please select all that apply)

Question Title

* 8. What subject(s) do you teach? (please select all that apply)

Question Title

* 9. Zip Code

Question Title

* 10. School District or Organization

If you work for a school, please enter the name of the district that your school belongs to. If you do not work for a school, please simply enter the name of the organization that you work for.

Question Title

* 11. Please enter the name of the curriculum kit you are using:

Question Title

* 12. Accession Number (barcode number)

Refer to the email you received regarding taking the survey to find the accession number of item borrowed. You can also look for the eight digit number associated with the item on top or side of the container that the items were packaged in.

Question Title

* 13. How have you used the kit? (please select all that apply):

Question Title

* 14. In what setting was this kit used? (please select all that apply)

Question Title

* 15. Was the kit used as a supplement for Tier 1 instruction?

Question Title

* 16. Was this kit a good supplement to your topic/unit? If so, please describe how the kit was used to supplement your unit.

Question Title

* 17. Are there other items that would be helpful to have in the kit?

Question Title

* 18. Is there any other feedback that you'd like to leave? (comments or technical issues that need our attention, including repair, missing components, items not working, etc.):

T