Teacher Interest Form Question Title * Demographics What is your name? What is your school name? What is your school mailing address? In what district is your school located? In what county is you school located? What is your preferred phone number that we can use to contact you? What is your preferred email address that we can use to contact you? Question Title * What grades do you teach? Yes No Middle School Middle School Yes Middle School No High School High School Yes High School No Question Title * Which courses do you anticipate teaching in either the Fall or Spring that could include the Love Notes and/or Relationship Smarts curriculum? Select 'Yes' to all that apply (Love Notes is used for high school students; Relationship Smarts is used for middle school students) Yes FCS Basics FCS Basics Yes Interpersonal Studies Interpersonal Studies Yes Principles of Human Services Principles of Human Services Yes Lifetime to Fitness and Wellness Lifetime to Fitness and Wellness Yes Human Growth and Development Human Growth and Development Yes Other Other Yes Other (please specify) Question Title * Please give your best estimate on the number of students who would be in the classes that you selected 'yes' to in the previous question. If you have multiple offerings of the same course, please list all of those that you would want to include the curriculum. Class 1 Class 2 Class 3 Class 4 Class 5 Question Title * Do the students in the Family and Consumer Sciences or other health-related classes you teach have in-class access to tablets/computers with Internet capability for completing web-based surveys? Yes No Question Title * Assurances Yes No I am willing to participate (virtually or in-person if possible) in a future Dibble curriculum training with the date and time TBD given reasonable notice. I am willing to participate (virtually or in-person if possible) in a future Dibble curriculum training with the date and time TBD given reasonable notice. Yes I am willing to participate (virtually or in-person if possible) in a future Dibble curriculum training with the date and time TBD given reasonable notice. No I am willing to complete an informed consent form for my role as a research subject. I am willing to complete an informed consent form for my role as a research subject. Yes I am willing to complete an informed consent form for my role as a research subject. No I am willing to sign and complete a letter of expectations for my role as a facilitator in instructing Dibble Institute Curriculum Love Notes/Relationship Smarts. I am willing to sign and complete a letter of expectations for my role as a facilitator in instructing Dibble Institute Curriculum Love Notes/Relationship Smarts. Yes I am willing to sign and complete a letter of expectations for my role as a facilitator in instructing Dibble Institute Curriculum Love Notes/Relationship Smarts. No I am willing to complete an online human subject protection training (takes approximately 1-2 hours) . I am willing to complete an online human subject protection training (takes approximately 1-2 hours) . Yes I am willing to complete an online human subject protection training (takes approximately 1-2 hours) . No I am willing to provide student class enrollment and attendance information (numbers only, no names included). I am willing to provide student class enrollment and attendance information (numbers only, no names included). Yes I am willing to provide student class enrollment and attendance information (numbers only, no names included). No I am willing to provide students with electronic links at specific times to administer pre-/post-surveys. I am willing to provide students with electronic links at specific times to administer pre-/post-surveys. Yes I am willing to provide students with electronic links at specific times to administer pre-/post-surveys. No I am willing to be observed in the classroom (or via video sharing program, such as Zoom) while teaching any approved CareerTech FCS course. I am willing to be observed in the classroom (or via video sharing program, such as Zoom) while teaching any approved CareerTech FCS course. Yes I am willing to be observed in the classroom (or via video sharing program, such as Zoom) while teaching any approved CareerTech FCS course. No I am willing to participate actively in all requests for my assistance and response. I am willing to participate actively in all requests for my assistance and response. Yes I am willing to participate actively in all requests for my assistance and response. No Question Title * Have you viewed the informational PowerPoint webinar for the OKBFP? Yes No, but I will The webinar can be found on the homepage of the OKBFP website at: https://www.socialinnovationlab.org/okbfp Question Title * Do you have any immediate questions at this time about the project? Question Title * How did you learn about this curriculum training opportunity? If you were recruited by a teacher currently participating in this project, please provide that teacher's name below. Thank you for completing the survey.Training for the fall 2020 semester has already taken place. Please watch for an email or call from Lynn Droescher who will keep in contact with you about future training opportunities to participate in this project. Done
