Thank you taking a few minutes of your valuable time to let us know how the training has helped you and how the WhyTry Program is working for you. This information is intended to help us better understand how we may best service our clients, how the Program is used, and how we might make it more effective for the youth we want to reach. Please select the appropriate response to each question and provide comments as necessary.

Name
Phone
Fax
Email
Mailing Address
School/Employer/Organization
School District
Are you part of an independent or unified school district?	Yes No
How many schools in your district?
Title/Position/Organizational Role
How long have you been in the role?
Do you train others in your school/district on the program?	Yes No
Do you supervise staff?	Yes No
Are you in charge of purchasing or do you recommend programs?	Yes No
How did you originally hear about WhyTry?
Do other teachers/associates use WhyTry in your school or oganization?	Yes No
Did you recieve training on the WhyTry Program?	Yes No
When?
Where?
If so, how long was the training?	Half-day Full-day Two-day Other
If yes then Did you receive the training from WhyTry or from someone in your school/organization?	Yes No
Did you purchase the program materials with the training?	Yes No Already had program Not Sure
Did you attend the training in your state or did you travel out of state for training?	In state Out of state
Following the training did you feel more confident in your ability to use the program?	Yes No Already felt confident Not Sure
If you have not recived training, was the WhyTry Curriculum Workbook Sufficeiently clear to allow you to succeed with the Program?	Yes No
Did you use WhyTry with your students/clients following the training?	Yes No
Do you still continue to use the program?	Yes No
If yes, Please explain how you have implemented Why Try in your school/place of employment (select all that apply)	Individual (one on one) Counseling Groups (outside of class) Classroom behavioral aid Afterschool program Alternative ed program School Wide Behavioral support
If you use the program in a group or classroon setting how often did your WhyTry group meet?	daily   weekly times/week other specify
What was the average length of each session?	ex.2hrs 30mins
How often did you use the Experiential Activities?	every session every other session other specify
Briefly describe how you used the WhyTry Music
Did you use the WhyTry Game Plan Journal?	Yes No
Please respond to the statements below
	1=Disagree, 3=Maybe, 5=Agree
The WhyTry Program met my expectations	1 2 3 4 5
The Visual Analogies seemed to make sense to the youth	1 2 3 4 5
The youth participated in and enjoyed the activities	1 2 3 4 5
The youth accepted and enjoyed the WhyTry music	1 2 3 4 5
The youth understood and remembered the concepts	1 2 3 4 5
The behavior of the youth reflected the Program concepts	1 2 3 4 5
What was the best part of the WhyTry Program?
What was the weakest?
What additional tools, if any, would your find helpful to add to WhyTry?
What type of funding did you use for WhyTry (select all that apply)?	Safe and Drug Free Schools(SDFS Grants) Safe Schools Healty Students Initiative Positive Behavioral Support Take Stock in Children School monies Gear Up Other specify
Will you use the WhyTry Program again?	Yes No
Have you tracked your outcomes or done research on WhyTry?	Yes No
Do you have any success stories of using WhyTry with students that you would be willing to share?