Please answer the following questions based on your recent viewing of Waking in Oak Creek. Thank you for your participation.
1) Screening Location: ____________________________________________________
2) How would you rate the following in reference to this film?
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5 Excellent |
4 Good |
3 OK |
2 Fair |
1 Poor |
a. Handling of topic presented |
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b. Overall impact of film |
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c. Effectiveness of group discussion (if applicable)
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3) Has this screening provided you with the following?
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Yes, very much |
Yes, somewhat |
No, didn’t make a difference |
Not applicable |
a. Information or tools you can use in your work |
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b. Increased motivation to prevent hate, intolerance, and/or bullying in your community |
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c. Deeper understanding of why hate crimes need to be reported, investigated, and prosecuted |
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d. Ideas for building relationships between diverse groups and faiths in your community |
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e. Ideas for improving relationships between community leaders, interfaith groups, and law enforcement |
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f. Deeper understanding of how to serve hate crime victims |
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4) What opportunities and/or challenges do you anticipate in using this film within your community or agency?
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5) What additional information or supplemental resources would you like to see presented in films and discussions to support your training and outreach efforts?
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6) Additional comments?
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7) Demographic Information
We request the following information to help us understand and better serve our audience. Thank you. |
a. Gender ☐Male ☐Female ☐ Other |
b. Age ☐12 or younger ☐13-18 ☐19-25 ☐26-35 ☐36-45 ☐46-55 ☐56-65 ☐66+ |
c. Ethnicity ☐Hispanic or Latino ☐ Not Hispanic or Latino |
d. Race ☐American Indian or Alaska Native ☐Asian ☐Black or African American ☐Native Hawaiian or Other Pacific Islander ☐White e. Constituency ☐Law enforcement ☐Student ☐Educator ☐Community member ☐Civic leader ☐Faith group member ☐Other__________________ |
f. Occupation |
Would you like get more resources or updates from Not In Our Town?
If yes, please provide: Name ________________________________________________
Phone ________________ Email ___________________________
Thank you for your participation!
For more information on how to prevent hate, intolerance, and bullying in your community, please visit the Not In Our Town website at www.niot.org.
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | gRace Carroll |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |