School-Wide Campaign Questionnaire with The Kiva Center
This is a preliminary questionnaire for school representatives who would like to initiate a school-wide campaign with The Kiva Center at their school. Please fill out this form to the best of your ability.
First and Last Name:
Name of School that you are Representing:
Your Position at the School:
Which type of School-Wide Campaign are you interested in running at your school?
Food Forest Design
Save the Bees
When would you like to launch this Campaign?
List your 3 top goals associated with this campaign.
Identify at least 3 barriers to addressing these goals (i.e. what is currently preventing your school community from working towards this cause?)
Please indicate ALL of the groups from which you have identified and reached out to at least one person to support this initiative? Groups include Teachers, Students, Parents, and Administration.
Does your school staff currently address the topic of concern in their lessons, weekly practices and classroom culture?
Yes. Most (50% or more) of the teachers have resources and weekly practices that they share with students regularly.
Some (less than 50%) of the teachers integrate these topics into their classes regularly while others do not.
Most (50% or more) of the teachers touch on these subjects at least 3 times per year.
Some (less than 50%) of the teachers touch on these subjects at least 3 times per year.
Most teachers do not address this topic in their classroom more than 2X per year.
Please choose the option that best describes your students' level of motivation in regards to this topic.
Highly Motivated (i.e. they ask questions in hopes to learn more or you see them practicing this outside of class)
Motivated (i.e. they seem interested and engaged when you discuss the topic in class)
Somewhat Motivated (i.e. they show some interest but do not demonstrate ongoing engagement in the topic)
Unmotivated (i.e. they do not seem to be interested in the topic)
BORED (i.e. they can't wait until it's over)
The Kiva Center School-Wide Campaigns range in their level of involvement, from the most basic to highly involved. Please choose the option that best describes the ideal Campaign Initiative with The Kiva Center.
Basic, Kiva-Led (Introductory Assembly, Class Resources, Follow-Up Assembly)
Basic, Student-Led (Kiva Mentors Students to Led Assembly, Student-Led Introductory Assembly, Class Resources, Student-Led Follow-Up Assembly)
Basic + Community Connectors (Introductory Assembly, Class Resources, Class Workshops, Follow-Up Assembly
All Levels Learning (Intro Assembly, Class Resources, Class Workshops, Teacher Training, Follow-Up Assembly)
Please choose the option that best describes the current funds that your school has available for a School-Wide Campaign (If you know the exact amount, write it in the category labeled 'Other'). Basic Level starts at $600.
Please include any additional questions and/or comments that you may have here.
Send me a copy of my responses.
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