Mourning Parents ACT, Inc.

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Student/Teacher Feedback Form

Feedback on

Presentation of Mourning Parents ACT, Inc.

Date: _________ School: ___________________________

We would appreciate your comments regarding our teen driver safety awareness program. Please take a few moments to answer the following questions. We value your input. Use the back of this form if you run out of writing room. Thank you.

Describe something you learned from the program.

 

 

 

What were the most memorable parts of the program?

 

 

 

Do you think this program will change your future behavior? If so, how?

 

 

 

Do you think this program is worth showing to teenagers? Please explain.

 

 

 

Do you want to send a personal message to the presenters? If so, please do.

 

 

 

Name: ________________________ (optional)

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Tear Here

 

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Website: MourningParentsAct.org

Facebook Group for Events: !MPACT – Mourning Parents Act, Inc.
Facebook FanPage: !MPACT

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P.O. Box 599, Coventry, CT 06238 (860) 742-8933 ······· Please Drive Safely, Someone Loves You!