Smart Smiles in School Kit Evaluation Form

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Smart Smiles in School Evaluation Form

Please take a moment to answer a few quick questions to help us improve our Smart Smiles® In School kits.

*Required

Your Information

Full name*

Full name* is mandatory

Job title*

Job title* is mandatory

Email*

Email* is mandatory

School name*

School name* is mandatory

Kit Evaluation

How many students in each of the following grades did the Smart Smiles In School program reach?*

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Please check at least one of the checkboxes

Please select at least one of the items

How did you use the flash drive?*

I did not use the flash drive.

Displayed content on a smart board or other projection screen.

Printed activity sheets from a computer to a printer.

Played videos on the Internet instead of playing the DVD.

Other

Please check at least one of the checkboxes

Please select at least one of the items

Was the flash drive a worthwhile addition to the kit?*

Yes

No

Please check at least one of the checkboxes

Please select at least one of the items

Which of the following kit items did you use to teach the children about oral health?*

Giant Tooth Model

Dental Floss

"Jack & the Hungry Giant" Book

Giant Toothbrush

"Land of Smiles" DVD

Grades K-3 Lesson Plans

Grades 4-5 Lesson Plans

Activity Sheets

Please check at least one of the checkboxes

Please select at least one of the items

Which activity sheets did you use?

Which activity sheets did you use? is mandatory

Was the kit well-organized and easy to teach?*

Yes

No

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Please select at least one of the items

If not, what could we do to make it faster and easier for you to teach?

If not, what could we do to make it faster and easier for you to teach? is mandatory

How would you rate the K-Grade 3 Kit?*

Excellent

Good

Fair

Poor

N/A

Please check at least one of the checkboxes

Please select at least one of the items

How would you rate the grades 4-5 kit?*

Excellent

Good

Fair

Poor

N/A

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Please select at least one of the items

Other comments

This field is mandatory

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