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First Name

Last Name

Email Address

City

State

School, Company, or Organization

Grade(s) Taught

Number of students expected to reach with the Activity Guides

Please use a whole number estimate, e.g. 20 (not 15-20, twenty, '20 students')

I am at least 18 years of age.

The following questions are optional and part of an effort to collect more data about the students being reached by the Activity Guides program. Please take a few moments to provide us with the following information.

Which of the following describes the educational setting(s) in which you teach?

If you work in a school, is your school receiving Title I funding this year?

If applicable, what percent of students in your educational setting are eligible to receive free or reduced-price meals?

Please leave blank if this question does not apply to your educational setting –or– use a whole number value, e.g. 20 (not 15-20, twenty, '20 percent')

What percent of students in your educational setting are described by each of the following categories?

American Indian or Alaska Native

Asian

Black or African-American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Two or More Races

Other