Participant Background Information: Please tell us about your self by answer the following questions or statement as accurately as possible.

Your Zip Code:

Gender: Male     Female

Your Occupation:

PART A:
Other Design, Content and Delivery:
The questions/statements in this section are designed to assess your perceptions of the quality of the other design content and delivery. Please answer each of the following questions/statements as accurately as possible.

1. Is it helpful to you, in your job, to receive this outreach material from WPBS-TV?
Yes     No
 

2. Is it beneficial for your organization to receive the resources packaged together, with the DVD and Teacher Guide?
Yes     No

3. Where will you use this information and resources provided to you?

In my job

In my social/personal life

In my family life

Other (please specify):

I do not plan on applying content.

PART B:
Learning and Awareness Raising:
The questions/statements in this section are designed to assess the extent to which you learned or raised awareness through participation in this other. Please answer each of the following questions/statement as accurately as possible.

1. Did you learn something new about the Antique Boat Museum through this DVD and/or Teacher Guide?

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

2. Did you learn something about North America's Boating Heritage through this DVD and/or Teacher Guide?

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

3. Were you aware of this outreach project, History at the Helm, before you received the DVD and Teacher Guide?
Yes     No

4.  How did you learn about this outreach project, History at the Helm?

Educational Services Newsletter

Website

Direct Mailing

On WPBS-TV's channel

Never knew about the project until now

 Other (please specify):

PART C:
Attitude Change:
The questions/statements in this section are designed to assess the extent to which you fromed or changed your attitudes through participation in this. Please answer each of the following questions/statements as accurately as possible.

1. Would you like to see more local history resources, such as this DVD and Teacher Guide, produced and distributed by WPBS-TV?

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

2. I would recommend these resources to a co-worker, a family member, or a friend?
Yes     No
 

PART D:
Behavior Change:
The questions/statements in this section are designed to assess the extent to which you changed your behaviors as a result of participation in this other. Please answer each of the following questions/statements as accurately as possible.

1. I will use the information provided in this DVD and/or Teacher Guide.
Yes     No

2. I will refer someone to use this DVD and/or Teacher Guide in their job.
Yes     No
 

PART E:
Suggestions/Request for Contact information:
We are very interested in making sure that our outreach efforts are meeting your needs. To this end, we would like to contact you in the future to examine how this workshop has helped you and determine how we can provide effective outreach in the future. Please feel free to leave this question blank if you do not wish to be contacted in the future.

1. Would you be willing to be contacted in the future to give us some follow-up feedback?
Yes     No

2. Is it better to reach you by: Phone     Email
 

3. What is your name?

4. What is your Email address?

5. What is your phone number?

Please provide us with any other comments you might have: