| PART 1: Coordinator Feedback |
| *Name of After School Program Coordinator |
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| *Organization Name |
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| *After School Program Name |
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| *Mailing Address (for mailing the Chapters gift card) |
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| *City and Province |
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| *Postal Code |
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| *Email |
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| Coordinator Phone Number |
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| *Date Completed |
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| *Number of Participants |
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How successful were we in meeting our goals?
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| POW helped to develop awareness that fresh water conservation is an environmental impact that everyone can make: |
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| POW encouraged kids and leaders to think about what individual actions can influence our water supply: |
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| POW aligned well with our organization's environmental stewardship goals: |
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How well did the POW package meet your needs?
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| The POW brochure provided a sufficient variety of doable activities to choose from: |
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| Instructions were easy to understand: |
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| The mail-outs (i.e. mood pencils, erasers, gift cards) were a postive incentive: |
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| The classroom poster was a useful item to include: |
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What changes would support greater use of POW with your after school participants?
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| Language and cultural diversity impacted our level of participation: |
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| I would prefer a single water theme for the year with fewer activities to choose from: |
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| Email is the most effective way of communicating with our organization: |
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| I prefer a greater variety of activities to choose from and theme variety: |
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| Suggestions/Comments to help us serve you better. |
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| PART 2: Participant Feedback |
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| Please read each statement to the participants and take a count, by a show of hands, for each category (Agree, Disagree, Uncertain). Reword each statement for clarity as you feel necessary. |
Water conservation is a difficult task, but is necessary to do.
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Agree |
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Disagree |
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Uncertain |
People usually waste the most water in the bathroom, so this is an easy area to target for water conservation.
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Agree |
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Disagree |
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Uncertain |
Some living things can live without oxygen, but none can live without water.
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Agree |
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Disagree |
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Uncertain |
There is a lot of water on Earth, but not much that we can drink.
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Agree |
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Disagree |
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Uncertain |
Most of Canada’s fresh, clean water is in rivers and lakes that flow to salty oceans, where it becomes unusable to drink.
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Agree |
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Disagree |
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Uncertain |
Everyone can play an important role in the quality and quantity of the water we will have to use both today and in the future.
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Agree |
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Disagree |
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Uncertain |
I often stop to think about how precious water is and how I am using and saving fresh water.
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Agree |
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Disagree |
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Uncertain |
There is a lot less water on Earth now than there was 100 years ago.
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Agree |
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Disagree |
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Uncertain |
The world’s supply of clean, safe water is under pressure.
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Agree |
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Disagree |
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Uncertain |
Special screens make certain that only rain goes down the storm water drains.
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Agree |
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Disagree |
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Uncertain |
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