Form:

Please complete the following before responding to the survey items.

1.  Name of your school (not district) _________________________________________
2.  Gender: ______ Male ______ Female
3.  Race/Ethnicity: ______ White (non-Hispanic)   _____ Black (non-Hispanic)   _____ Hispanic
                            ______ Asian/Pacific Islander   _____ American Indian/Alaskan Native
                            ______ Other (specify) ______________________________________
4.  What grade level(s) are you currently teaching? ______________________________
5.  Please provide your total number of years of teaching experience. _______________
6.  Please list the courses/subject areas you are currently teaching and the number of students in each:

        ____________________________________________        ________

        ____________________________________________        ________

        ____________________________________________        ________

        ____________________________________________        ________

        ____________________________________________        ________

        ____________________________________________        ________
 

Please rate the professional development activity you just attended:

                            Excellent    Good     Average     Fair        Poor

Informative              _____     _____     _____     _____     _____

Interesting               _____     _____     _____     _____     _____

Useful                     _____     _____     _____     _____     _____

Good use of time     _____     _____     _____     _____     _____

Practical                  _____     _____     _____     _____     _____

Comments:
 

Developed by the Child Study Center
Department of Educational and School Psychology
Indiana University of PA