"Where Does the Evidence Lead?" Feedback form

1. Your name:   

2. Your email:   

3.  Did the DVD package arrive usable and undamaged?

            YES                 NO 

     if no, describe:

4.  Did you personally view the DVD?
            YES                 NO 

5.  Did you encounter problems viewing the DVD?  If so, please describe. 

            YES                 NO 

        if no, describe:

6.  Did you show all or part of the DVD to your classes?  If parts, which parts?

            YES                 NO 

       describe:

7.  How would you rate the overall quality of the DVD on a scale of 1 to 10, with 1 being poor and 10 being outstanding?

        (1-10)

8.  Did you share the DVD with any other teachers?

            YES                 NO 

       describe:

9.  Did you use the DVD outside of school (church, home, home-schools, etc.?)

            YES                 NO 

describe:

10.  Approximately how many students viewed either all or parts of the video, in either your classes or your colleagues classes?

number:

11.  Were the students receptive to the video?

            YES                 NO 

describe:

12.  Did you encounter any retribution for showing or trying to show the video?

            YES                 NO 

describe:

13.  Did you receive any positive or negative feedback from students on the video?

            YES                 NO 

describe:

14.  Did you receive any positive or negative feedback from parents on the video?

            YES                 NO 

describe:

15.  Do you have any suggested "next videos" you have seen and would recommend?

describe:

16.  Do you have any suggestions for improving our DVDs to teachers program?

describe:

17.  Please include any additional comments, including ones relating to questions above (referenced by number) below.  (1000 char. max.)

Please consider helping in some way.

Thank you!