First name *

Last name *

Email *

Phone Number

School

District or Organization *

City *

Zip Code *

Please check the workshop that you plan to attend: *

San Jose – March 14, 2012Oakland – February 15, 2012San Diego – February 23, 2012

How did you find out about Nourish? Check all that apply:

Word of mouthFriend/colleagueYour school/districtAnother non-profit or community organizationInternet searchWebsitePBS broadcast

Other

We would like to make sure we customize each workshop to the specific audience. Please let us know a little more about you.

What is your occupation? Check all that apply:

TeacherAfterschool educatorSchool garden coordinatorHealth and wellness professionalSchool administratorFood service staffFarm-to-school advocateNon-profit service provider working in K-12 schoolsNon-profit service provider not working in K-12 schoolsGovernment agency workerInformal educatorParent

Other

What grade level do you teach? Check all that apply:

K123456789101112

What subject area(s) do you teach? Check all that apply:

General EdScienceSocial StudiesLanguage Arts/EnglishMathHealthP.E.

Other

What type of school do you teach in?

PublicCharterIndependent

How many years have you been teaching? Check one:

1 year1-3 years4-9 years10+ years

How would you rate your level of knowledge about food system concepts, from 1 (no knowledge) to 5 (extensive knowledge)?

12345

Have you used Nourish materials? If yes, please explain.

Is there anything specific you are hoping to learn from the workshop?