2013
We would like to know more about individual activities in the BEPA Toolkit. Please take a few minutes to answer these questions after you have used an activity in the toolkit.
Instructor Name___________________ Location (County, School)____________________
Age Group: Number of Students:
Activity Name (list the name of the activity you are evaluating):
Nutrition Curriculum (list both the curriculum and the specific lesson):
Nutrition Message (list the key message that you selected from the toolkit):
Time Spent on Physical Activity (Including Setup):
I. Please rate your level of agreement with the following statements (circle one for each).
Please relate your responses to the
BEPA Toolkit Activity you indicated above (Activity Name).
1. The activity was easy to set up, implement, and explain to the children.
Strongly
Disagree
Disagree Agree Strongly
Agree
1 2 3 4
2. Children enjoyed the activity.
3. The activity was age appropriate.
1 2 3 4
1 2 3 4
4. The equipment needed for the activity was found in the toolkit (aside from writing/drawing paper, writing implements).
5. There was a clear connection between the activity and the associated nutritional message.
6. I felt confident teaching this activity lesson to the children.
1
1
1
2
2
2
3
3
3
4
4
4

If you rated any items as 1 (Strongly Disagree) or 2 (Disagree), please explain why you gave this rating.
List any additional comments you wish to share about the activity.