Teacher Feedback Form

for Celebrate Safety - Break the Silence - Yell and Tell. Please return your completed form to your school's Celebrate Safety Facilitator.

Your name (optional) _______________________________

Your school ______________________________________

1. Please circle the grade you teach. Pre K 1 2 3 4 5 6 2. Please circle the curriculum used. Celebrate Safety, Break the Silence/Yell and Tell

2. Please attach additional sheets as necessary. Your input can help improve the program as well as assist in the fundraising needed to ensure that all students everywhere have access to the vital information in this curricula.

3. How useable was this program?

4. Which parts of the program do you feel were most valuable to your students? Why?

5. Which parts of the program were most valuable to you? Why?

6. Do you feel more comfortable dealing with issues of abuse as a result of this program? Please feel free to elaborate on your answer.

7. How did the parents of your students respond to the program?

8. Do you have any suggestions for others on how to reinforce the lessons learned in this curriculum throughout the remainder of the school year?

9. What was the overall student response to the program? Do you feel that it has made a lasting impression on the children? Please feel free to share any anecdotes you may have.

10. Is this a program you would like to use year after year with your students? Additional comments, concerns, or ideas?

Thank you for your input!

Teacher Testing Report Form

Both the diagnostic and post tests for Celebrate Safety and Break the Silence- Yell and Tell are meant to determine whether or not the program has accomplished its objectives. These are not meant to be reading tests. If children have difficulty with reading or staying on task, the teacher, parent volunteer, or cross-age tutor may read the questions to the students and assist as needed to determine what the child has actually gained from the classroom presentation.

The "Teacher Use Only" box at the top of each test is optional. It may help you organize your information for the following questions. However, you may choose to ignore it.

Teachers, thank you for taking the time to complete this form once you've completed the program and graded the tests. Please be sure return this form to your facilitator!

1. Please circle the grade you teach. Pre K 1 2 3 4 5 6

2. Please circle the program you used. Celebrate Safety and/or Break the Silence/ Yell and Tell

3. How many boys ___________ and how many girls ___________ took the tests?

4. How many children in your class belong to each of the following ethnic groups?

Asian ____________Hispanic_____________White____________

Black ____________Native American_________Other__________

5. How many children in your class are:

LEP (Limited English Proficient) __________ Learning Handicapped___________

Chapter 1 __________ Other_________________________________________

6. What percentage of children received 100% on the diagnostic?_____________ What percentage of children missed 1 on the diagnostic? __________________ What percentage of children missed 2 on the diagnostic?__________________ Was there one question most commonly missed and/or one incorrect response most frequently given on the pretest? What was it?

7. Please give the numbers of students and corresponding percentages of the class receiving the following grades on the post-test. NUMBER OF STUDENTS PERCENTAGE OF CLASS

90% - 100% _________________________ ________________________

80%-89% __________________________ _________________________

70%-79% __________________________ __________________________

60%-69% __________________________ __________________________

Below 60% ___________________________ ________________________

Do you have any comments about the scores?

Was there one question most commonly missed and/or one incorrect response most frequently given on the post-test? What was it?

Do you have any other comments or concerns?

Thank you so much for your cooperation and commitment to child safety issues!

next: Story of the Little Child