Please give us your feedback.

 
Name:
School Name:
School City:
School State:
Grade Level(s) Viewing the Film:
Total Number of Students Viewing the Film:
How did you hear about the Teen Pregnancy: Real Lives, Real Choices DVD?:
Do you plan to show the DVD to classes in the future? Why or why not?
Specifically, what information presented in the video was new to your students?
Did you use the provided curriculum handout in conjunction with the video? Why or why not?
Was the curriculum easy to understand and use?

On a scale of 1 to 10, how much of a positive impact do you feel Real Lives, Real Choices will make on your students’ lives (circle one)?

One Two Three Four Five Six Seven Eight Nine Ten

None                                                             Some Impact                                           Life Changing
Any comments or questions: