Implementation Survey

Please take a few minutes of your time to fill out this teacher survey regarding the Lions Quest program. This information helps the Lions Clubs International Foundation to track the Lions Quest program and evaluate its effectiveness in the classroom as well as target areas for improvement. *Please note that the first nine fields are required fields.

*Participant Name:
*Grade Level/Position:
*School/Agency:
*State:
*Email:
*Fax:
*Type of Workshop
(e.g. Skills for Growing, Skills for Adolescence, Skills for Action, etc.)
*Workshop Date:
*Trainer:
 
Implementation
  1. Please estimate the number of people from your school who have been trained in Lions Quest:
  2. Are you currently implementing the Lions Quest program?
    Yes
    No
     
  3. Do you plan to use all of the units or certain units only?
    All Units
    Certain units only
     
  4. How are you implementing the program?
    Separate Course
    Integrated into an existing course
     
  5. If you are not currently implementing the program, do you plan to implement the program in the next few months or the next year?
    Yes
    No
     
    If no, why?

     
  6. Estimate the number of students who have participated in the class this school year and in which grades:
  7. Is the Lions Quest program implemented school-wide?
    Yes
    No
     
  8. Are you using the student materials?
    Yes
    No
     
Impact
  1. Have you seen a positive change in your students after beginning to implement the program? Please rank.
     
    U = unable to know
    0 = no change
    1 = very little change
    2 = moderate change
    3 = many students changed
    4 = majority of students have changed
     
    U01234
    Increase in academic achievement 
    Increase in respect in the classroom 
    Decrease in disruptive behavior 
    Decrease in drug use 
    Increase in volunteerism 
Lions Support
 
  1. Did you work with your local Lions Club?
  2. Do they support you financially?
Training
  1. What were the most positive and lasting aspects about the Lions Quest training?
  2. What improvements, if any, would you recommend for the training?
  3. Would you be interested in a refresher online course?
    Yes
    No
     
  4. Would you be interested in one of the following staff development workshops?
     
    Service Learning   Teens: Alcohol and Other Drugs
    Anger Management/Bullying Prevention   Positive Classroom Discipline
          High School SEL & Life Skills

     
Ongoing Support
  1. Is there any additional support Lions Quest could provide in making the program more effective in your school?
  2. Would you recommend Lions Quest to other schools/teachers?
    Yes
    No
     
  3. Do you have any further comments you would like to share with trainers, educators, and/or Lions?
 
 
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