The Black Panthers Evaluation Toolkit
Thank you for partnering with ITVS to present Indie Lens Pop-Up screenings of The Black Panthers in your
community! The enclosed evaluation tools will help us measure our success in raising awareness, increasing
knowledge, and inspiring action amongst event participants nationwide. Please help us capture feedback from
participants at your events by distributing copies of this survey at your event(s) and in a follow-up email to your
event mailing list.
We will prepare a summary report of national findings from these surveys for our funders and the filmmakers.
We will share a summary of these results with you, including the results for your city.
Included in the toolkit are:
●
A paper survey for you to photocopy for distribution to all participants at your event(s). Please note the
first page (Part 1) is to be completed before the film screening, and the second page (Part 2) is to be
completed after the film screening.
●
A package of 50 Indie Lens Pop-Up pens to give away to audience members who complete the
survey
Tips to increase the number of surveys collected at your event(s):
1. Place a survey on every seat in your screening room, or post a staff member or volunteer at the
entrance to hand surveys to participants entering the theater
2. Have your moderator make an announcement at the beginning of the event and at the conclusion of the
event, encouraging participants to complete the survey
3. Announce the $100 Amazon Gift Card giveaway as an incentive to complete the survey
4. Post a staff member or volunteer at the exit at the conclusion of the event to collect surveys and remind
participants to complete the survey
5. Place a box or basket, clearly labeled “Completed Surveys” on your information or registration table
Please send all completed paper surveys to:
The Black Panthers Audience Survey
c/o ITVS, Engagement
651 Brannan Street, Suite 410
San Francisco, CA 94107
AUDIENCE SURVEY
PART 1 (Before the Film)
Complete both sides of this survey for a chance
to win a $100 Amazon gift card! Provide your email
address on page 2 to enter the prize drawing.
Winners will be announced March 2016.
Your feedback will help us understand if we are meeting our mission of engaging with diverse audiences, and will help us
shape future events to better serve community needs. Your responses will remain confidential. Thank you for your time!
1. Location of Screening Event (City/State): ___________________________________
2. Are you a member of your local PBS station?
3. What is your current age group?
4. What is your gender?
[ ] Female
[ ] Under 18
[ ] Male
[ ] yes
[ ] no
[ ] 18 – 34
[ ] not sure
[ ] 35 – 49
[ ] 50 – 69
[ ] Over 70
[ ] Other: _____________________
5. How would you describe yourself?
[ ] Latino/Latina [ ] African American [ ] Asian American/Pacific Islander [ ] Middle Eastern
[ ] Native American/Native Alaskan [ ] Caucasian [ ] Multiracial [ ] Other: _____________________
6. What is the highest level of formal education you have completed?
[ ] Elementary School [ ] Middle/High School [ ] College/University [ ] Graduate School
[ ] Vocational/Technical School [ ] Not Applicable [ ] Other: _____________________
7. What is your home zip code? __________________________
8. Which of the following best describes your main means of watching films and video? Select no more than two:
[ ] Watch live broadcast television
[ ] Watch on an “over-the-top” device (Apple TV, Roku, Google TV, etc.)
[ ] Watch recorded television (e.g. DVR or TiVo) [ ] Watch online, on a computer (Netflix, Hulu, Amazon, etc.)
[ ] Other: ________________________________
9. Have you ever attended an Indie Lens Pop-Up event before?
[ ] Yes [ ] No [ ] I'm not sure
10. Had you heard of the PBS series Independent Lens prior to attending today’s event?
[ ] Yes [ ] No [ ] I'm not sure
11. How would you rate your current level of awareness about the history of the Black Panther Party?
(1 = not at all aware; 5 = very aware)
1
2
3
4
5
12. At this moment, on a scale of 1-5 (1 = not at all likely; 5 = very likely) how likely are you to…
Take time to learn more about the Black Panther Party
1
2
3
4
Do something to get involved locally around racial justice issues
1
2
3
4
Donate to or become a member of your local PBS station
1
2
3
4
5
5
5
1
AUDIENCE SURVEY
PART 2 (After the Film)
Complete both sides of this survey for a chance
to win a $100 Amazon gift card! Provide your email
address on page 2 to enter the prize drawing.
Winners will be announced March 2016.
Please complete this side of the survey at the conclusion of the event
1. Your email address (optional): _________________________________________________________
2. How would you rate your current level of awareness about the history of the Black Panther movement?
(1 = not at all aware; 5 = very aware)
1
2
3
4
5
Please explain:
3. At this moment, how likely are you to… (1 = not at all likely; 5 = very likely)
Take time to learn more about the Black Panther Party
1
2
3
4
5
Talk to friends or family about racial justice issues
1
2
3
4
5
Get involved in and/or take action around racial justice issues
1
2
3
4
5
Donate to, or become a member of your local PBS station
1
2
3
4
5
Watch The Black Panthers when it airs on Independent Lens on PBS
1
2
3
4
5
Attend future Indie Lens Pop-Ups
1
2
3
4
5
4. If you are likely or very likely to get involved locally around racial justice issues, please tell us what action you
are considering taking:
5. Please feel free to share additional comments about The Black Panthers film and today’s event:
6. Would you like to receive the Independent Lens e-newsletter to receive updates on upcoming films?
[ ] yes
[ ] no
2