Feedback Form - Earth Day New York


		Help improve our program to help you effectively spread environmental awareness!

Please provide us with the following information by filling out the form below,
or, if you prefer, download the form as a Word document by clicking here.

Name:

Position:

School Name

School Address:

State:

Zip:

Phone:

Fax:

School URL:

Email 1:

Email 2:

My School is:

Private Public Parochial Elementary
Middle High

Approximate Student Population:
Approximate Number of Computers in School:

Please select one option from each of the following statements.

I have received the Education Program Packet:

Once Twice 3-5 times More than 5 times

I distribute the information to other teachers in my school.

Always Often Sometimes Rarely Never

Teachers in my school use the information in the packet.

Always Often Sometimes Rarely Never

The materials in the packets are useful for teachers.

Strongly Agree Agree Neutral Disagree Strongly Disagree

The materials in the packet are useful for students

Strongly Agree Agree Neutral Disagree Strongly Disagree

Materials with more related topics would be useful. (e.g. pieces on rainforests).

Strongly Agree Agree Neutral Disagree Strongly Disagree

I would like to have the materials separated by grade or age group.

Strongly Agree Agree Neutral Disagree Strongly Disagree

I have contacted an organization in the packet for more information.

Once Twice 3-5 times More than 5 times

My school has computers with Internet access for:

Teachers: Yes No Students: Yes No

Teachers use computers in the classroom to conduct a class online.

Always Often Sometimes Rarely Never

Teachers download and print material from the Internet for class.

Always Often Sometimes Rarely Never

Supplemental online material provided by the Education Program would be useful.

Strongly Agree Agree Neutral Disagree Strongly Disagree

On a scale of 1 – 5, please rank the following:
(1=strongly agree, 2=agree, 3=neutral, 4=disagree, 5=strongly disagree)

I would like to receive more printed materials.

1 2 3 4 5

I would like to receive more information about online resources.

1 2 3 4 5

I would like to receive emails with environmental educational ideas.

1 2 3 4 5

I would like to visit Earth Day New York’s website for materials and ideas.

1 2 3 4 5

Materials that I like are (check all that apply):
	Curriculum
	Poster contests
	Other contests
	Product information
	Online Activities
	Organization's program information

Other Comments:

Earth Day New York 201 East 42nd St. Suite 3200 New York, NY 10017 Tel: 212-922-0048 Fax: 212-922-1936 info@earthdayny.org