Please take a few minutes to look at the enclosed materials and complete this survey.
Please return the survey to:
- Penquis Community Action Program
- ATTN: Covering Kids and Families Campaign
- P.O. Box 1162
- Bangor, ME 04402-1162
OPTIONAL INFORMATION:
School name: _____________________________
Your Name: _____________________________
Position: _____________________________
PLEASE CIRCLE THE BEST RESPONSE TO EACH QUESTION OR FILL IN THE BLANK.
1. Do you currently teach about health insurance coverage to your students?
Yes No
2. At what grade level(s) do students receive health insurance information?
None 7 8 9 10 11 12
3. What subject(s) cover this topic?
Health Mathematics Social Studies Other:
4. What was your initial reaction to receiving this packet of materials?
Very Interested Somewhat Interested Not Interested
5. How helpful is this information to you?
Very Helpful Somewhat Helpful Not Helpful
6. Do you plan to use any of the information in this packet in your classes?
Yes No Not Sure
7. Please share with us any thoughts or comments: (use the back of the page if necessary)
Thank you for taking the time to let us know your reactions to this material.