Validation Code:

Please enter the validation code that you found on the telescope. The validation code helps us verify that you checked out a telescope to complete this program. *

Information on your school:

School: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Information about your library

Please tell us the library location where you checked out the telescope: *

Information about your class or program audience:

Grade levels *

The number of students participating in the program: *

	# Students
Total	# Students
Girls	# Students
Boys	# Students
African-American	# Students
Hispanic	# Students
Native American	# Students
Disability	# Students

Pre and Post Test Analysis

Please tell us how many students responded correctly/incorrectly to each question for both the pre-test and post-test: *

	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #1	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #2	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #3	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #4	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #5	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #6	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #7	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #8	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #9	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect
Question #10	Pre-Test Correct	Pre-Test Incorrect	Post-Test Correct	Post-Test Incorrect

Feedback on the program:

Please indicate your appraisals on a scale of 1 to 5:

	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
1. Telescope checkout was easy to schedule	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
2. Telescope was available at a time that fit my curriculum	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
3. Telescope was easy to operate	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
4. Operating directions were clear and complete	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
5. Students were interested in using the telescope	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
6. Use of the telescope fit into the curriculum or extended the curriculum	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
7. Activities provided were useful	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
8. The checkout and return processes were quick	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
9. The length of time for the telescope loan was sufficient	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable
10. I would recommend the Solar Telescope Program to my colleagues	1 = Strongly agree	2 = Agree	3 = Neutral	4 = Disagree	5 = Strongly disagree	6 = No reply/not applicable

If you have comments about the program, and particularly suggestions for changes and improvements, please indicate them here:

Additional information and activities (optional):

If you would like to receive additional information and activities as they become available, please provide an e-mail address. It will not be used for other purposes or for communications other than those related to Saint Louis Astronomical Society education programs. These are planned to be very low volume communications. Your Email address (optional):