2015-2016 Class Data Collection
Thank you for sharing the Amgen Biotech Experience with your students.  We hope to keep sponsoring and supporting this program.  Please have EACH participating teacher at your school answer this short questionnaire, so that we may compile data (for July 1, 2015 - June 30, 2016) that is now mandated by the national office. Our program funding depends on every teacher completing this survey as accurately as possible.  If you have any questions about how to complete the form correctly, please ask your center coordinator.

If you use the ABE materials multiple times during the school year, please compile all of the data for the ENTIRE year in your responses.  Your input is incredibly important -- please fill this information promptly after teaching the ABE curriculum.  
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Last Name *
First Name *
School Name *
Also indicate HS for high school, MS for middle school, JHS for junior high school.
School District *
Please spell out name (eg. type Los Angeles, not LA)
School Street Address *
School City *
School Zip Code *
School Phone Number *
Format ###-###-#### ext. ###
Distribution Center *
From which site do you pick up the Amgen program materials?
Is this YOUR first year doing ABE? *
Is this your SCHOOL's first year doing ABE? *
What materials did YOU receive from the ABE program? *
Kit includes reagents/consumables and equipment needed to conduct the lab sequences
How many students in TOTAL did YOU teach with ABE materials during the 2015-2016 school year? *
Only count the # students that YOU taught directly with ABE.
How many CLASSES/sections in TOTAL did you teach with ABE materials during the 2015-2016 school year? *
Example:  For two Introductory Biology classes and one AP Biology class, enter 3
How many different types of COURSES total did you teach with ABE materials during the 2015-2016 school year? *
Example:  For two Introductory Biology classes and one AP Biology class, enter 2.
Questions about your ABE use in specific course(s) this school year
Course #1 Level
Course # 1: ABE Labs Implemented
Check all that apply. Note that if you only did part of a lab series/sequence, please select "Other" and indicate which labs you actually did.
Course #1: Comments  
Add any comments or additional information
Course #2 Level
Course # 2: ABE Labs Implemented
Check all that apply. Note that if you only did part of a lab series/sequence, please select "Other" and indicate which labs you actually did.
Course #2: Comments  
Add any comments or additional information
Course #3 Level
Course # 3: ABE Labs Implemented
Check all that apply. Note that if you only did part of a lab series/sequence, please select "Other" and indicate which labs you actually did.
Course #3: Comments  
Add any comments or additional information
Course #4 Level
Course # 4: ABE Labs Implemented
Check all that apply. Note that if you only did part of a lab series/sequence, please select "Other" and indicate which labs you actually did.
Course #4: Comments  
Add any comments or additional information
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