Demographic Survey 2017-18
In order to receive government and foundation support, it is necessary for Kentucky Shakespeare to keep an accurate record of our audience demographic statistics. All responses will be treated with the strictest confidence.

Please complete this Demographic Survey and submit it to KY Shakespeare at the end of the program.

Kentucky Shakespeare does not discriminate in any of its programming or hiring practices on the basis of race, color, religion, national origin, age, sex, or disability.

Teacher Last Name
Your answer
School/Venue
Your answer
Name of Education Performance/Workshop
Required
Date of Program
MM
/
DD
/
YYYY
Please Note Actual Numbers of Attendance:
Total Student Attendance
Your answer
Caucasian
Your answer
African American
Your answer
Hispanic or Latino
Your answer
Native American or American Indian
Your answer
Asian / Pacific Islander
Your answer
Multi-Racial
Your answer
Can you list any special needs that your students have that were a part of the program? (I.E. Visual Impairment, Autism, Physical Mobility, etc.)
Your answer
Do you think that we were able to meet their needs or were there areas of improvement that we can focus on for the future?
Your answer
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