Florida Fish & Wildlife Conservation
Commission
620 South Meridian Street
Tallahassee, FL 32399-1600
(850) 488-4679
http://myfwc.com/educator/K12.html
Project WILD National Office 5555
Morningside Drive, Ste 212
Houston, TX 77005
(713) 520-1936
Participant Survey Form
1. Please print in pen :
Date: _____________
__ Facilitator(s): _________________________
_____ __________
Name: _____________________________________________________
Address: ________________________________________
State: __
____ County: ______
_ City: __________
________________
_____________ Zip: _____________ Phone #: _______
Business/School Name: ________
Address: ______
____________________
___
__________________________________________________
____________________ City: ___
_______________ State: _____ Zip: ________
Email:
The above information is needed for our database as proof that you have participated in a Project WILD workshop.
2. Position:
a.
b.
c.
d.
e.
Elementary teacher
Secondary teacher
Principal
Superintendent
Curriculum specialist
f. Resource agency person
g. Business/industry representative
h. Private conservation group representative
i. Youth organization representative
j. Preservice teacher
3. I have received a copy of Project WILD Activity Guide:
___ yes
___ no
4. I am interested in using the Project WILD materials:
___ yes
___ no
k. College student
l. College faculty
m. Other _____________
n. ___________________
o. ___________________
5. If answer to 4 is “yes,” the ages with which I am most likely to use Project WILD are: (if you work with a non-school
group, choose the grade level closest to the age group)
a.
b.
c.
d.
K-3 (primary)
4-6 (intermediate)
5-8 (middle)
7-9 (jr. high)
e.
f.
g.
h.
10-12 (high school)
K-6 (all elementary grades)
K-12 (all grades)
13-16 (college)
i. K-16 (all grades)
j. Graduates/adults
k. K-adults (all levels)
6. The audience with whom I am most likely to use Project WILD are: (choose all that apply)
a.
b.
c.
d.
School students
e. General public
Pre-school students
f. Teachers
Scouts/4-H/youth groups
g. Church/community groups
Nature centers/camps h. Student teachers
i. Environmental conservation groups
j. Resource agency personnel
k. Industry groups
l. Other __________________________
7. I am most likely to use Project WILD material with the following number of people per year:
a. none
b. 1-30
c. 31-60
d. 61-120
e. 121-250
f. 251-500
g. 501-1000
h. 1001-5000
i. More than 5000
j. other _____________________
__________________________
__________________________
Continued on back
_
8. How did you hear about this workshop?
a. Facilitator
b. Professor/Teacher
c. Friend/Colleague
d. Project WILD Website
e. School District
f. Nature Center/Park
g. Flyer was posted (where? _______________)
h. Other ______________________________
9. I would be interested in the following from Project WILD, if possible in the future: (choose all that apply)
a. An opportunity to become a certified Project WILD facilitator
b. An opportunity to participate in (additional) Project WILD workshops (i.e. Black Bear or Schoolyard Wildlife)
c. Additional background information about ___________________________________________________
d. Guest speakers or resource people about ___________________________________________________
e. Related materials for students such as _____________________________________________________
9. Ways in which this workshop could have been improved include:
a.
b.
c.
d.
e.
More actual hands-on activities
More suggestions for how to use these materials with students/teachers
More background information to increase my knowledge
Other ______________________________________________________
None, I have no suggestions
10. On a scale of 1 to 5 rate the following: (5 = excellent, 3 = average, 1 = poor)
Usefulness of activities for classroom/work
5
4
3
2
1
Project WILD Staff presenting workshop
5
4
3
2
1
Project WILD Materials
5
4
3
2
1
Interaction with others
5
4
3
2
1
Instructional Strategies
5
4
3
2
1
Variation of activities
(i.e. active vs. passive, outside vs. indoor)
5
4
3
2
1
Time allotted for each activity
5
4
3
2
1
Hands on Activities (overall)
5
4
3
2
1
Overall Workshop
5
4
3
2
1
11. Comments, suggestions, requests, concerns, etc.:
Thank You!