Web Survey

“Building Trust Within Schools” – CD Feedback Form

I’d Appreciate Your Help! After you’ve had a chance to listen to the enclosed CD, I’d appreciate your feedback. This would be useful to me in creating future CD’s. Please take a few minutes to fill out this feedback sheet and mail it to me in the enclosed envelope or fill it out online at www.insightinnerjourneys.com. Thank you for your assistance!!

Please circle an appropriate number and write down any comments / suggestions you might have on the line under the numbers.

5 = highest level of agreement 1 = lowest level of agreement

1. Did you like the sequence of the material (e.g. Intro. – story – discussion – strategies)?

5
4
3
2
1

2. Did you find the topic of Trust in classrooms and schools to be pertinent for your job?

5
4
3
2
1

3. What is the likelihood you’ll try some of the strategies and action steps in your classroom or school?

5
4
3
2
1

4. What is the likelihood you’ll discuss the topic of trust and some of the ideas covered in the CD with other educators?

5
4
3
2
1

5. Rank each track: 1 = I really liked it 2 = It was OK 3 = It wasn’t that useful

Story.

1
2
3

Discussion.

1
2
3

StrategiesActionSteps.

1
2
3

6. How was the flow (speed, voice, music) of the CD for listening and holding your attention?

5
4
3
2
1

7. Would you purchase additional CDs in this series, including topics such as Communication, Leadership, Community, Accountability and others?

5
4
3
2
1

8. Would you attend a workshop on the topic of building trust in classrooms and schools?

Yes
No

9. Would you participate in a discussion group on the topic of building trust in classrooms and schools?

Yes
No

9A. Comments:

10. May I use some of your comments in promoting my book and CDs? I would use only your first name or initials.

Yes
No

If I may quote you or if you’d like to be on my mailing list to receive information about future CDs or the publication of my book, please fill out the next section. This personal information won’t be shared.

First Name

Last Name

Address 1

Address 2

City

State / Province / Region

Zip / Postal Code

Home Phone

Work Phone

E-mail

Fax

THANK YOU FOR YOUR TIME AND ASSISTANCE!

First Name
Last Name
Address 1
Address 2
City
State / Province / Region
Zip / Postal Code
Home Phone
Work Phone
E-mail
Fax