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Name:
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School or district: |
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Email:
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Telephone:
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Administrator
Teacher
Other
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Age group you serve:
(Check all that apply)
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Elementary
Middle/Jr. High
High
School
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How many years
have you been using the Weller Center's
programs?
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0 years
1 - 5 years
6 - 10 years
More than 10 years
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How did you
first learn about the Weller Center?
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Teacher
Administrator
Parent/PTO/PTA member
Mailed communications
News media
Website
Other
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What do you feel are the biggest challenges faced by
your district?
(Check all that apply)
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Budget
constraints
No Child Left Behind
Changing
demographics
Others (please explain):
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Specifically regarding health and character education, what
are the biggest issues faced by your students?
(Check all that apply)
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Drug and
alcohol use
Destructive decision making
Bullying and
violence
Nutrition, BMI and eating disorders
Stress, suicide
and emotional health issues
Early sexual contact and
sexuality issues
Others (please explain):
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In what
areas do you feel your school/district could benefit from
supplemental health education programs from the Weller
Center?
(Check all that apply)
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General health
and wellness
Drug, alcohol and tobacco prevention
Nutrition,
fitness and body image
Character education and emotional
health
Reproductive health/growth and
development
Others (please explain):
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What
other sources of preventive health education do you use in
your
school(s)?
For
example, DARE, specific character education curricula,
etc.
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What other class trips and/or assembly programs do your
students
participate in?
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Are you
primarily interested in learning more about:
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Programs delivered at the Weller
Center's teaching facility and interactive museum
The Weller Center's
high-impact assembly programs that travel to your
school
Both
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When do
you finalize your budget for class trips and
assemblies?
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Summer
Fall
Winter
Spring
There is no deadline for finalizing
plans
Other
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Funding for preventive health education programs and other
class trips and assemblies
in your school district comes from the
following sources:
(Check
all that apply)
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Operating
budget
Grants (Safe Schools funding, etc.)
PTA/PTO
Other
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Check the following to learn more about:
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The Weller Center's new baseline survey for determining student
health risk behaviors
Certified continuing professional education workshops
The academic
standards our programs and enrichment packets address
Free preventive
health education resources
Other
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Other
comments or questions:
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