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Thank you for taking the time to complete the information below.  It is imperative that these questions are completed as accurately as possible.  Please make sure all totals for each section match the total number of students in question #4.  This information will be shared with the Arizona Supreme Court who funds the iCivics Arizona Program!  Thank you!!!

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* 1. Teacher Name:

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* 2. Teacher Email Address:

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* 3. School Information:

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* 4. Which grade level(s) do you teach?

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* 5. Approximately, how many students were impacted by playing the iCivics.org games?

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* 6. Approximately, how many minutes did your students track playing the iCivics.org games?

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* 7. Approximately, how many students received a McDonald's Smoothie Coupon?

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* 8. Date range for iCivics lessons and games implementation:

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* 9. Approximately, how many students were impacted by playing the iCivics.org games during the 2014-2015 school year for the demographics (Gender) below?

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* 10. Approximately, how many students were impacted by playing the iCivics.org games during the 2014-2015 school year for the demographics (Age) below?

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* 11. Approximately, how many students were impacted by playing the iCivics.org games during the 2014-2015 school year for the demographics (Race) below?

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* 12. Of the number of participants listed under Race, estimate the number of participants who are of Hispanic ethnic origin:

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* 13. Of the participating students who played the iCivics.org games, approximately how many students were enrolled/not enrolled in school?

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