* 1. What school are you affiliated and grade do you teach?

  Pre K Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade Other
Cotaco
Danville Elementary
Eva Elementary
Falkville
Lacy's Spring
Priceville Elementary
Sparkman
Union Hill
West Morgan Elementary

* 2. Have you referred a child/children to the FACT program?

* 3. What services did you refer them for? Check all that apply.

* 4. Did the child/children receive the assistance they were referred to FACT for?

* 5. Did you notice a change in the child/children's classroom performance after the referral?

* 6. Did you notice an improvement in parental involvement after you referred a child/children to FACT?

* 7. Did the FACT program staff respond to the referral in a professional manner?

* 8. Did the FACT program staff respond to the referral in a timely manner (within one week of the referral)?

* 9. Do you feel the FACT program has been helpful to you as an educator?

* 10. Do you feel the FACT program and its services improved your classroom environment?

* 11. Additional Comments:

T