Teacher Empowerment Interest Form

Teacher Empowerment Interest Form

by Be F.R.E.S.H
Thank you for your interest in our Be F.R.E.S.H program. Our Teacher Empowerment workshops are designed to enhance social emotional learning, positively impact attitudes and commitment towards school, and equip teachers and staff with tools to create stronger, more positive relationships with students.

Our interest form is used to gauge your school sites' social emotional needs. The information you will provide will allow us to create the best experience for your teachers and staff.

Please complete each section and submit upon completion.
Point of Contact Name*
Point of Contact Position*
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone #*

Area CodePhone Number
Contact Email*
example@example.com
Will you be providing lunch?

YesNo
Request Start Time for Lunch

Hour Minutes

AM/PM Option
What time can the facilitators access the room for set-up (at lease an hour is needed)?
ex. 8am-10am
CHALLENGES
What are the top challenges your school faces daily?*

Students don't show responsibility for their actionsTeachers and students seem unmotivatedTeachers/Staff have limited support systems to help them develop positive relationships with studentsThere is a lack of campus culture and community on school siteOther
What are the biggest BEHAVIORAL issues you see at your school?
What are the biggest ACADEMIC issues you see at your school?
What do you hope your staff will gain from the Be F.R.E.S.H Teacher Empowerment workshop?
What results do you hope to see in the school, teachers, classrooms, and students as a result of this workshop?
What other information would be helpful for the facilitators to know about the school, teachers, and students?
Any other recommendations that will assist us in gearing the workshop to the participants' needs?
Additional Questions
We may need to utilize the walls in the room. What would you suggest to use to hang signs, posters, etc?

StaplesTapeTacksStick Tack
Please check each item to confirm that you will provide it:

Internet AccessProjector with audio & visual connections (to be plugged into a laptop)Name Tags for all participants2 Flip chart stands2 Flip Chart Pads (prefer non Post-It style)Colored Pens for each participantTables and chairs for all participants - facing the facilitatorsMusic System with AUX cordTable at the front of the roomExtension CordOne 4x6 index card for each participantPower Strip
Have the participants attended any Be F.R.E.S.H workshops within the past 2 years?
How did you hear about us?*

LinkedInInstagramFacebookReferralGoogle SearchBe F.R.E.S.H WebsiteOther
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Teacher Empowerment Interest Form

CHALLENGES

Additional Questions