Teacher After School Quarterly Implementation Log Form

Appendix 15: After-school Instructor School-Year Quarterly Implementation Log Form

N ational Aeronautics and Space Administration

www.nasa.gov

Summer of Innovation School-Year Quarterly Implementation Form

Greetings!

The National Aeronautics and Space Administration (NASA) is conducting a national evaluation of its Summer of Innovation (SoI) Program. Abt Associates Inc. and its partner the Education Development Center have been hired to conduct this study. The goal of the study is to explore how SoI is being implemented and assess the outcomes related to the implementation of SoI across the country. 

This form is intended to document the implementation of the SoI student school-year activities across the awardee sites each month. You have been asked to complete this quarterly form based on your role in the SoI student school year activities.  Completing this form will help NASA understand awardees' efforts with students during the school year.  We will be sending you this form quarterly between September and June. We estimate that it will take approximately 10 minutes on average to complete.

Privacy and Participation

Your participation in the study is voluntary and nonparticipation will have no impact on you or your SoI awardee organization. Your responses to this survey will be protected under the Privacy Act. There is minimal risk of breach of confidentiality, and we have put in place procedures to minimize this risk. You will never be identified by name, and information from the evaluation will only be reported in the aggregate.

If you wish to participate in this study please click Next.

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Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. Return this form by entering the submit button when you are finished. You can find additional information on this program at http://www.nasa.gov/offices/education/programs/national/summer/home/index.html. You may send comments on our time estimate above to: NASASummerofInnovation@abtassoc.com. Please send only comments relating to our time estimate or comments to this address, not the completed form. If you have questions about this evaluation, please contact the evaluation director, Hilary Rhodes of Abt Associates Inc. at (877) 520-6840 (toll-free) or send an email to NASASummerofInnovation@abtassoc.com. If you have questions about your rights as a research participant, you contact Teresa Doksum, the Abt Institutional Review Board Administrator at (877) 520-6835.

A. Activity Information

Site Name (e.g., name of school, community learning center, YMCA)
Program Name (if different than above)

Did your site work with students using NASA Summer of Innovation (SoI) content and/or activities in the last 3 months [enter which 3 months]?

• Yes

• No [ EXIT FROM SURVEY – THANK YOU & SUBMIT BUTTON TO APPEAR]

Total number of days NASA SoI content and/or activities were used in the last 3 months [enter which 3 months]	Limit to numeric characters (max 3 values)
Total number of contact hours NASA SoI content and/or activities were used in the last 3 months [enter which 3 months]	Limit to numeric characters (max 3 values)

[Site Information – Only asked on first quarter form]

Do students at your site experience NASA SoI content and/or activities through an existing out-of-school time program? (i.e., SoI is integrated into the program’s overall curriculum)

• Yes

• No

Programming note: If yes, continue.

Does this existing program receive funding from any of the following federal or state-wide grant programs? Check all that apply.

• 21^st Century Community Learning Centers

• Federal TRIO programs (e.g., Upward Bound, Talent Search)

• GEAR-UP program

• Other, please specify:________________

• None of the above

What type of existing program is SoI integrated? Check one only.

• School or district run program

• University-affiliated outreach program

• Local nonprofit, community, or faith-based community program

• Other, please specify:_______________________________

Is the focus of the existing program’s curriculum primarily science, technology, engineering, and/or mathematics (STEM) subject matter? Check one only.

• Yes

• No

Programming note: Section “all”.

B. Content Information

Below is a list of the NASA units that were identified for SoI. Please indicate which ones you used in the last 3 months [enter which 3 months]. Check all that apply.

Earth & Space Science

• Climate and Seasons IF SELECTED, ASK:

Which Climate and Seasons lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Climate (Globe Soil Learning Activities: Soil Temperature; How Does Earth’s Energy Budget Relate to Polar Ice?; Surface Color and Effect on Temperature Change; What is the Right Answer?)

• Seasons (Habits of the Mind; Is Grandpa Right, Were Winters Colder When He was a Boy?; Kinesthetic Astronomy; Seasonal Change on Land and Water)

• Other, please specify

• Destination Mars (Can We Take it with Us?; Mars Bound)

• Earth Moon System IF SELECTED, ASK:

Which Earth Moon System lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Earth’s Attic: The Moon (Lava Layering; Moon Math: Craters!; Reaping Rocks; Regolith Formation)

• The Sky is Falling (Finding Impact Craters; Falling the Falling Meteorite; Lava Layering; Searching for Meteorites; Space Rocks! A Meteorite Game)

• Other, please specify

• Planetology IF SELECTED, ASK:

Which Planetology lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Earth: A One of a Kind Planet? (Assessing Planets as Candidates for Life; Astro-Venture: Search for and Design a Habitable Planet!); Mars and Earth Physical Comparison)

• Finding Earth-like Planets (Count Your Lucky Stars, Detecting Planet Transits; Paint by Numbers)

• How Does Earth Compare? (Earth, Moon, Mars Balloons Activity; Exploring Planet Sizes; Solar System Missions; Walking the Planet Distances)

• Other, please specify

• Remote Sensing IF SELECTED, ASK:

Which Remote Sensing lessons were presented? Select one or more.

• A World of Change (Paint by Numbers; Quantifying Changes in the Land Over Time)

• Earth Versus Mars (What Similar Physical Processes Occur on Both Earth and Mars; Charting the Physical Characteristics of Both Earth and Mars)

• Finding Impact Craters

• Finding Water Systems (Hydrology Investigation: Model a Catchment Basin)

• Other, please specify

• Universe IF SELECTED, ASK:

Which Universe lessons were presented? Select one or more.

• Is It Safe? (Astroventure Geology Mission; Space Weather Action Centers)

• Points of Light (Counting Your Lucky Stars; Hubble Deep Field Academy; Light Pollution Star Count; Stories in the Sky)

• What’s in the Stars? (Cycles in the Cards; Elements and You; What’s Out There)

• Other, please specify

• Weather IF SELECTED, ASK:

Which Weather lessons were presented? Select one or more.

• Air has Weight and Temperature Affects it? (Does Air Have Weight? How Do You Know?; Can You Show That Temperature of Air Has an Effect on Its Weight and Its Weight and Direction of Vertical Movement?)

• Moisture and Clouds (Does Cloud Type Affect Rainfall?; How Much Water is Available in the Atmosphere for Precipitation?)

• What Influences Planetary Weather (Coriolis Effect; Atmospheric Science, Geology, and Design a Planet)

• Other, please specify

• Year of the Solar System IF SELECTED, ASK:

Which Year of the Solar System lessons were presented? Select one or more.

• Comet on a Stick

• Make a Comet and Eat it

• Scale Models of the Solar System (Exploring Planet Sizes; Walking Planet Distances; Solar Pizza)

• Solar System Missions

• Solar System Simulator (Solar Pizza; The Schoolyard Solar System)

• Space Rocks! A Giant Meteorite Board Game (Space Rocks! A Meteorite Game)

• Vegetable Light Curves

• Where Do We Choose to Live and Why? (United States at Night)

• Other, please specify

Life Science units

• Body IF SELECTED, ASK:

Which Body lessons were presented? Select one or more.

• Brain in Space (Find Your Way Around Without Visual or Sound Cues; How Quick are Your Reflexes?; Vestibular-Ocular Reflex; Visualizing How the Vestibular System Works)

• Space Adaptations (Bag of Bones; Get a Leg Up; Hole-y-Bones; O2-How Much?; Vomit Comet)

• Train Like an Astronaut (Base Station Walk-Back; Crew Strength Training; Do a Spacewalk!; Jump for the Moon; Mission: Control!)

• Other, please specify

• Food (Food Preparation for Space; Food Selection; How Much is Waste?; Mold Growth; Planning and Serving Food; Ripening Fruits and Vegetables)

• Life Out There? IF SELECTED, ASK:

Which Life Out There lessons were presented? Select one or more.

• Astrobiology: Life Here and Out There (Are Microbes Alive? Could Life Exist in Other Places in the Solar System; Do You Think Aliens Exist?; Do the Mystery Samples Contain Life?; Is it Living; Now What Do You Think About the Possibility of the Life in the Universe; What Does Life Need?; Where Does Life Live?)

• Habitable Zones (Astrobiology in Your Classroom: Life on Earth… and Elsewhere?; Fingerprints of Life; Sun’s Habitable Zone)

• Search for Life On Other Worlds: Observing and Classifying Life (Animal Antics; Are Two Eyes Better Than One?; Creature Feature)

• Search for Life on Other Worlds: What is Life and What Does it Need to Live?

• Shapes and Food Chains (Chain Games; Supporting Structures; Weighty Questions)

• Other, please specify

• Plants IF SELECTED, ASK:

Which Plants lessons were presented? Select one or more.

• Have Seed Will Travel

• How do Plants Know Which Way to Grow? Tropisms (Space Garden)

• Light Effects On Plant Behavior (Can Photosynthesis Occur on Saturn?; Phototropism: Do Plants Prefer the Blues?; Phototropism: How Little Light Will Bend a Seedling?)

• Living Clocks (Plant Leaf Movement)

• Other, please specify

• Survival IF SELECTED, ASK:

Which Survival lessons were presented? Select one or more.

• Cool Spacesuits (Cool Suits; Keeping Your Cool)

• Field Trip to the Moon (Ecosystem Investigation; Engineering Investigation; Geology Investigation; Habitation Investigation; Medical Investigation; Navigation Investigation)

• Survivor: The Space Environment (Chain Reaction; Exploration Then and Now – Human Needs; Modeling Radiation-Damaged DNA; Solar Radiation and SPF Levels)

• Other, please specify

Physical Science and/or Engineering units

• Aeronautics IF SELECTED, ASK:

Which Aeronautics lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Air Foils (The NASA Why Files: The Case of the Challenging Flight)

• Bag Balloons

• Beginners Guide to Aeronautics (Aerodynamics of Baseball / Soccer)

• Bernoulli and More Bernoulli (The NASA Why Files: The Case of the Challenging Flight)

• Controlling the Plane (The Straw Plane Experiment 1-4)

• Designing Aircraft in 5 Easy Steps: It’s a Challenge! (The Design Center, The Design Laboratory, The Poster Activity)

• Fluttering Fun, Point of Balance (The NASA Why Files: The Case of the Challenging Flight)

• Four Forces of Flight (The NASA Why Files: The Case of the Challenging Flight)

• Getting off the Ground into the Smart Skies (LineUp with Math Educator Guide)

• Getting the Drop on Flight with the “X” Planes (Constructing and Testing the Ring Wing Glider, Constructing the X-33)

• Jet Propulsion

• Learning the “Wright” Way to Fly! (Engineering the Sled Kite, NASA Connect: the “Wright” Math)

• Other, please specify

• Challenges IF SELECTED, ASK:

Which Challenges lessons were presented? Select one or more.

• Electrodynamic Propulsion

• On Target Challenge

• Spacecraft Structures

• Thermal Protection Systems Challenge

• Touchdown Challenge

• Other, please specify

• Design Process IF SELECTED, ASK:

Which Design Process lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Build a Solar Oven

• Lunar Plant Growth Chamber

• Mars Pathfinder Egg Drop Challenge

• Project X51 Water Rocket Construction (Rocket Activity Project X-51)

• Spaghetti Anyone? Building with Pasta (NASA “Why?” Files: The Case of the “Wright Invention”)

• Space Place: Make a Balloon Powered Nanorover (Build a Nanorover; Be Glad You’re Not a Cyclops1; Marsdial: Show Me the Way to Go Home)

• Student Glovebox: Droplet Investigation of Liquids

• Water Filtration System

• Other, please specify

• Exploration IF SELECTED, ASK:

Which Exploration lessons were presented? Select one or more.

• Crew Exploration Unit

• Landing a Rover

• Moon Rovers

• NASA Simulations

• Other, please specify

• Forces and Motion IF SELECTED, ASK:

Which Force and Motion lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Danger: Space Debris (Aerogel-lo: Technology for Studying Comets, Collision; Potato Astronaut – Exploration Brief: Micrometeoroids and Space Debris)

• Inertia and Friction (Newton Car; Racing Against Friction)

• Thrust, Air Pressure, Rockets and Newton’s Third Law (Balloon Staging; Pop Can Hero Engine; Rocket Pinwheel; Rocket Races)

• What Goes Up… Must Come Down: Projectile Flight (3…2…1 Puff!; Accelerometers; Foam Rocket; Pop! Rockets)

• Other, please specify

• Gravity IF SELECTED, ASK:

Which Gravity lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Fighting Gravity – A Matter of Balance (Fluttering Fun; Point of Balance; Heavy Lifting)

• Gravity Games

• Heavy Duty Topics (Falling Weight Apparatus; Inertial Balance; Mass vs Weight; Pendulums)

• Other, please specify

• Properties of Matter IF SELECTED, ASK:

Which Properties of Matter lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Composite Materials (Museum in a Box)

• Nature of Salt

• Reaction Rates (Antacid Tablet Race)

• Space Weather (Build a Magentometer; Radiation Exposure on Earth; Space Weather Action Center; What’s Hidden Inside?)

• States of Matter (3-2-1 Pop!, Heat as the Agent of Change: Atoms and Molecules in Motion; Liquid Rainbow; Potato Float)

• Student Glovebox

• Other, please specify

• Robotics IF SELECTED, ASK:

Which Robotics lessons were presented? Select one or more.

• Heavy Lifter

• Robotics: Hands Down!

• Using Robotics

• Other, please specify

• Rocketry IF SELECTED, ASK:

Which Rocketry lessons were presented? Specific activities associated with each lesson are italicized. Select one or more.

• Heavy Lifting Air Engines (Air Engines; Heavy Lifting; Vectoring)

• Nose Cone Aerodynamics (Adventures in Rocket Science)

• Ride the Wind: Compressed Air Rocketry (High-Powered Paper Rockets; Pop! Rockets)

• Other, please specify

• Waves and Optics IF SELECTED, ASK:

Which Waves and Optics lessons were presented? Select one or more.

• Making Use of the Electromagnetic Spectrum (Amazing Rays, Investigating Ice Worlds)

• Manipulating Waves (Exploring Diffraction with a Spectroscope/Constructing a Spectroscope; Simple Magnifiers; Space Operations Learning Center)

• Wave Measurements (Intro to the Electromagnetic Spectrum; Red Shift, Blue Shift; Simple Spectroscope; Wavelength and Energy; What’s the Frequency, Roy G Biv?)

• Other, please specify

Please provide any additional NASA content and/or activities that were used during the month of [enter month].

C. Additional Activities

Did students participate in any NASA SoI field trips or special activities/events in the last three months [enter which 3 months]? Check all that apply.

• Attended a rocket or space shuttle launch event

• Participated in a live video downlink event from the International Space Station or Space Shuttle

• Toured a NASA Center or facility

• Visited a science museum, science center, or planetarium

• Other, please specify

• None of the above

D. Educators who led the NASA SoI activities

Total number of educators who worked with students using NASA SoI content and activities at your site in the past 3 months [enter which 3 months]	Limit to numeric characters (max 3 values)
How many are K-12 classroom teachers?	Limit to numeric characters (max 3 values)
How many are K-12 informal educators? (e.g., community learning center educator)	Limit to numeric characters (max 3 values)
How many are university faculty or staff?	Limit to numeric characters (max 3 values)
How many are pre-service teachers?	Limit to numeric characters (max 3 values)
How many are Americorps volunteers?	Limit to numeric characters (max 3 values)
How many are other types of educators? Please specify: ______________	Limit to numeric characters (max 3 values)

Display note: “Number of individuals entered for Items A-F should equal Total number of educators who worked with students using NASA SoI content and activities”

Did the educators at your site participate in a NASA SoI professional development training before starting to use NASA SoI content and/or activities during the school-year?

• Yes

• No

Programming note: If yes, continue. If no, skip to All section.

What percent of the educators participated in professional development training before starting to use NASA SoI content and/or activities during the school year?

What percent of the educators participated in a NASA SoI professional development training before starting to use NASA SoI content and/or activities during the school year? Enter a percent (e.g., 90)

______% Limit to numeric characters (max 3 values)

Programming note: All

Please provide any additional information you would like to share with us about the NASA SoI activities at your site.

Thank you for completing this survey.

SUBMIT

If any questions left unanswered prompt with: WARNING: One or more questions remain unanswered. Complete questions as desired and click “SUBMIT” to finish.