Southwest Education Alliance
Joining Forces for Education
 
Survey for Extended Contact Hours

This Survey must be submitted within four weeks following the workshop. 
 
 
 
When completing the following form, use the TAB key to maneuver.  Striking the ENTER key will submit the form.

Name 

School District 

School Name 

School Address 

City, State, Zip 

Email Address

Area Code           Phone        Fax 

Title of Workshop 

 

Question 1: Write a high quality narrative describing in detail what has been integrated in your planning/teaching.

 

Question 2: Write a high quality description of the increase in student learning as a result of implementing new learning and strategies from the workshop. 

 

Please print a copy of the completed survey for your records before submitting this form.  Once the survey is submitted, reviewed and accepted a certificate will be mailed directly to your school.  If you have any questions regarding the 6+4 Plan, please contact the Southwest Education Alliance at 704-687-8823 or by email.