On The Road For Safety
Data Collection Form
Email address *
County of Residence *
Your answer
Adult Coordinator Name *
Your answer
Today's Date *
MM
/
DD
/
YYYY
Location of Today's Presentation? *
Your answer
Number of Student's Taught? *
Your answer
How comfortable are you presenting the material? *
Not at all Comfortable
Very Comfortable
Are students responding positively to the material? *
Seemed Slightly Bored
Very Engaged
Were you able to ask the students the pre/post test questions? *
Did you do any additional activities with the students? *
In answered yes to above question, please provide a brief description of the activity.
Your answer
Do you have suggestions for improving the program/lesson? *
Your answer
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