Home
Contact
Questionnaire
First Name
Last Name
Email Address
Questions (1-13)
1. Enter a Creative Title for the Learning Example you are sharing:
2. Think back and share about the most powerful learning experience you've had recently.
3. What category best matches the experience you are sharing?
Select one...
Self Directed Learning
Project-Based Learning
Teacher-Inspired Moment
Parent-Supported Opportunity
4. How often do you think the young people in your community get to have that kind of experience? Why do you think that is?
5. What do you think might need to change about the education system to make that kind of experience more common?
Any additional notes?
BACKGROUND
6. What is your role? Check all that apply.
Community Leader
District Leader
Family Member (who is not also an educator)
School Leader
Student
Teacher
Other School Staff
Current College Student
Higher Education Faculty
Policy Maker / Legislator
Pre-Service Teacher / Education Prep Program
Business / Industry Member
7. If you are a current student, what best describes your grade?
Elementary K-5
Middle 6-8
High School 9-12
8. Have you or someone in your circle been served under an IEP or 504 plan?
Select one...
Yes
No
9. In what county do you reside?
10. What is your age?
Select one...
Over 55
45-54
35-44
25-34
18-24
Under 18
11. What is your gender?
Select one...
Male
Female
Prefer Not To Say
12. What is your ethnicity?
Select one...
White/Caucasian
Hispanic/Latino
Black/African American
Native American/ American Indian
Asian/ Pacific Islander
Other
13. What is the highest level of school you have completed?
Select one...
Still in School K-12
High School degree
Bachelor's degree
Master's degree
Doctorate
Trade School Certificate
Associate's degree
Military Commendation
Your submission has been received!
Thank you for your participation.
Oops! Something went wrong while submitting the form.
Questions?
We're here for you.
info@innovatek12.org
+1 973-818-1825
Headquartered in Florida, USA
Join the Community
Receive insights
and updates
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
