OMB control #:
Expiration date:
Survey I.D. # _______
Timucuan Explorer Evaluation Survey: POST-TEST (Day 2)
This survey seeks to asses your feelings and thoughts while participating in the Timucuan Explorer Kayaking Program. It will take 10 minutes to complete the survey. Feel free to ask questions. Your responses will remain anonymous.
1. Are you a (check one):
Girl
Boy
2. What is your age? ______
3. What is your grade level in school? ______
4. Tell us one new thing you learned about recreation today.
_____________________________________________________________
5. Tell us one new thing you learned about nutrition today.
_____________________________________________________________
6. Tell us one new thing you learned about nature today.
_____________________________________________________________
7. Tell us one new thing you learned about the Kingsley Plantation today.
_____________________________________________________________
8. Use the following boxes below to tell us what you liked about the kayaking program (check one for each).
For example:
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Not at all: |
A little: |
A lot: |
I |
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X |
I |
X |
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a. How much did you like …
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Not at all |
A little |
A lot |
Learning about nutrition |
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Learning about slavery |
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Being on the water |
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Playing in the plantation yard |
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Kayaking |
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Being in nature |
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Finding out about plantation life |
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Being with friends |
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Leaving my neighborhood for a little while |
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Eating healthy food |
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9a. I felt________ when I saw the slave quarters (check all that apply):
Angry
Sad
Proud
Scared
Happy
Brave
Bored
Confused
Excited
Lucky
9b. Circle one word in the list above that best describes how you felt about the slave quarters (from question #9a).
10a. I felt _______when I saw the slave owner’s plantation house (check all that apply):
Confused
Happy
Angry
Sad
Proud
Lucky
Scared
Brave
Bored
Excited
10b. Circle one word in the list above that best describes how you felt about seeing the plantation house (from question #10a).
11a. When I’m in nature, I feel (check all that apply):
Bored
Upset
Sad
Scared
Happy
Relaxed
Brave
Confused
Excited
Concerned
11b. Circle one word in the list above that best describes how you felt about being in nature (from question #11a).
12a. Kayaking made me feel (check all that apply):
Healthy
Angry
Motivated
Scared
Brave
Tired
Bored
Confused
Excited
Energized
12b. Circle one word in the list above that best describes how you felt about kayaking (from question #12a).
PRIVACY ACT and PAPERWORK REDUCTION ACT statement:
16 U.S.C. 1a-7 authorizes collection of this information. This information will be used by park managers to better serve the public. Response to this request is voluntary. No action may be taken against you for refusing to supply the information requested. Your name is requested for follow-up mailing purposes only. When analysis of the questionnaire is completed, all name and address files will be destroyed. Thus the permanent data will be anonymous. Please do not put your name or that of any member of your group on the questionnaire. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Person collecting and analyzing information: John Eisler, Ph.D., Dept. of Psychology, University of North Florida, Jacksonville, Florida 32224-2673, phone (904) 620-1633.
Burden estimate
statement: Public
reporting burden for this form is estimated to average 10 minutes per
response. Direct comments regarding the burden estimate or any other
aspect of this form to: Daniel Tardona, Timucuan Ecological and
Historic Preserve, 12713 Fort Caroline Road, Jacksonville, Florida
32225, phone (904)
221-7567.
File Type | application/msword |
File Title | Survey I |
Author | Recreation, Park & Tourism Sciences |
Last Modified By | Megan McBride |
File Modified | 2007-05-03 |
File Created | 2007-05-03 |