Summer Institute Questionnaire

A. About You
First and Last Name:  
Name you wish to go by (If different):  
How did you learn about the Summer Institute:  
Home Mailing Address:  
Preferred Contact Number:
Work Email:  
Other Email:  
Special Dietary Needs: Vegetarian   Vegan  Other  
Where will you be staying during the Summer Institute: Please select  
B. About Your Educational Context
   Check if you are a college student, and skip to number 5.  
1. Your role/position (classroom or community teacher, a media specialist/librarian, an administrator,etc.)
2. The name of the school or organization where you work?
3. Who do you teach within your educational context (ages/grade levels/special characterisitics etc.)?
4. What do you teach/do (e.g., subject or content area)?
5. College Students Only: What program are you currently in, and what subjects and grade levels do you plan on teaching on the future?
C. About your interests
The following information will help us plan the presentations and mini-lessons on Wednesday and Thursday of the Institute. Please select up to 4 topics related to media literacy that you would be most interested in learning more about during this institute:
Gender/Body Image/Sexuality Race/Ethnicity/Culture Politics/Elections
Media Violence/Conflict Resolution Social Activism
Environmental Issues Film Analysis
Drugs/alcohol/tobacco News/Journals
Nutrition/Food Choices Copyright Issues
Common Core Standards  
D. Familiarity with Media Literacy
1. Have you ever been at a presentation by Chris Sperry or Cyndy Scheibe (from Project Look Sharp) about media literacy before? If yes, how long (full-day training or shorter workshop) and where?
2. Have you ever used any of the Project Look Sharp curriculum kits or other materials? If yes, please describe.
3. Have you attended other training or workshops about media literacy? If yes, describe.
E. Do you already have a project tentatively planned for integrating media literacy into your education context Yes   No
If yes, please describe briefly, including whether it has a possible media production component.
Note: Please bring any materials that you might want to include in a media project (if you have one in mind).

F. Technology

We will be providing Ipads and PC/Windows laptops during the institute. We encourage you to bring your own laptop if you desire to work after hours.

Indicate your level of experience below by selecting on the dropdown box:

Indicate your level with learning and using new technologies:
Are your students able to access mobile learning devices fairly easily (i.e., iPads/Tablets, iPhone or other, Laptops)? If yes, please describe all and specify "other" if needed.
Please tell us anything regarding technology that you feel will help us better understand and meet your needs regarding the afternoon media production component.
Please tell us about any educational technology tools that you are interested in learning more about.
Please indicate any hardware that you plan to bring with you (Smartphone/Tablet/Laptop and their types).

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