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Deliberative Questionnaire
Please complete the questionnaire below.
Name
First
Last
I am a:
I am a:
Administrator
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Parent
Student
Teacher
Other
Institution/Organization Name
Title
Phone
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What opportunities are you interested in learning more about? (click all that apply)
Professional Development
Curriculum Development
Customized Civic Engagement Program
Student Deliberations
How would your school or district be most interested in participating in a national student deliberation event in the fall?
I would like to include a middle school cohort
I would like to include a high school cohort
We would offer this opportunity to a targeted segment of the student body, department, or course.
It would be a fully optional activity in which students could participate.
Other:
If answered other:
Are you a High School or Middle School?
Choose one
High School
Middle School
Middle School Cohort
Choose One
Would like to include a middle school cohort
We would offer this opportunity to a targeted segment of the student body, department, or course.
It would be a fully optional activity in which students could participate.
Other:
High School Cohort
Choose One
Would like to include a high school cohort
We would offer this opportunity to a targeted segment of the student body, department, or course.
It would be a fully optional activity in which students could participate.
Other:
If answered other:
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