OCALI Lending Library - Curriculum Kit Evaluation

1.Patron Name
2.Email Address
3.Are you a person with a disability?
4.Are you a family member of a person with a disability?
5.Are you a professional working with a person with a disability?
6.Title/Role
7.What grade level(s) do you teach? (please select all that apply)
8.What subject(s) do you teach? (please select all that apply)
9.Zip Code
10.School District or Organization

If you work for a school, please enter the name of the district that your school belongs to. If you do not work for a school, please simply enter the name of the organization that you work for.
11.Please enter the name of the curriculum kit you are using:
12.Accession Number (barcode number)

Refer to the email you received regarding taking the survey to find the accession number of item borrowed. You can also look for the eight digit number associated with the item on top or side of the container that the items were packaged in.
13.How have you used the kit? (please select all that apply):
14.In what setting was this kit used? (please select all that apply)
15.Was the kit used as a supplement for Tier 1 instruction?
16.Was this kit a good supplement to your topic/unit? If so, please describe how the kit was used to supplement your unit.
17.Are there other items that would be helpful to have in the kit?
18.Is there any other feedback that you'd like to leave? (comments or technical issues that need our attention, including repair, missing components, items not working, etc.):