Rivers to Oceans Week Feedback Form

	HELP US SERVE YOU BETTER Please take two minutes to complete this Rivers to Oceans Week (ROW) feedback form. Your valuable input will help us serve you better. Your response will be CONFIDENTIAL.
1. Please indicate how you received this ROW kit. (Check ALL options that apply.)
I received it in the mail.		My colleague gave me the kit.
I contacted your office and requested a kit.		My principal gave me the kit.
I saw it posted in our school’s staff room.		I picked it up at a conference.
Other
(Please specify)
2. ROW kits are produced annually. How many did you receive over the past five years?
Never, this is my first kit. (If you pressed "never", skip to question 4.)
I received one or two 2 kits.		I received three or four kits.
I have all five kits.
3. Indicate how many ROW kits you kept for future use over the past five years.
None.		One or two kits.
Three or four kits.		All five kits.
Not applicable
4. Where do you live?
(City/town)		(Province/territory)
5. Indicate if you have participated in CWF programs: (Check ALL options that apply.)
Project WILD	WILD School	Space for Species	Below Zero
Other
(Specify):
6. TEACHERS who teach in formal school systems, please complete this section.
a. What grade(s) do you primarily teach? Grade(s)
b. What subject matter do you primarily teach?
Science	Math	Language Arts	Physical Education
All subjects	Art	Other
		(specify):
c. If you are a Resource Teacher or Librarian, indicate how you distribute resources such as this kit.
I post it in the staff room		I display it in the school library.
I circulate an announcement		Other
		(specify):
7. EDUCATORS who work outside formal school systems, please complete this section. Indicate which option(s) best describe(s) you. (Check ALL options that apply.)
I work at a nature centre.		I am a Park Interpreter.
I work at a public library.		I am self-employed.
I work / volunteer for a youth organization
(specify):
Other
(specify):
8. Supply contact information for FREE resources (Optional). Indicate your preferences. (Check ALL options that apply.)
Send me future updates and FREE resources by mail.		Send me updates by e-mail.
Invite me to participate in reviews, surveys and research.
Send me FREE classroom resources.
Name:		E-mail:
Mailing Address:
Telephone:
Thank you for your time.
Submit		Reset

HELP US SERVE YOU BETTER

Please take two minutes to complete this Rivers to Oceans Week (ROW) feedback form. Your valuable input will help us serve you better. Your response will be CONFIDENTIAL.