TIMU Post-Intervention Survey

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:

	Not at all:	A little:	A lot:
I like the smell of cookies			X
I like the smell of stinky gym socks	X

a. How much did you like …

	Not at all	A little	A lot
Learning about nutrition
Learning about slavery
Being on the water
Playing in the plantation yard
Kayaking
Being in nature
Finding out about plantation life
Being with friends
Leaving my neighborhood for a little while
Eating healthy food

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.

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