Midterm Survey Midterm Survey Name* First Last Grade level* Preschool/Head Start Elementary Middle School High School School Name* Address Street Address City State Zip Code Unified Sports Please enter the total number of unique/individual athletes or Unified partners so far in the school year. Unified athletesPlease enter a number greater than or equal to 0.Unified partnersPlease enter a number greater than or equal to 0.Pre-k to 2nd gradeYoung Athletes athletesPlease enter a number greater than or equal to 0.Young Athletes partnersPlease enter a number greater than or equal to 0.3rd to 12th gradeDuring the FALL season (Aug-Dec), did your program implement any of the following UNIFIED Sports?Check all that apply: Select All Badminton (AIA) Bocce Bowling Soccer Swimming Golf Number of Badminton Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Badminton Unified Sports partners*Please enter a number greater than or equal to 0.Number of Bocce Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Bocce Unified Sports partners*Please enter a number greater than or equal to 0.Number of Bowling Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Bowling Unified Sports partners*Please enter a number greater than or equal to 0.Number of Soccer Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Soccer Unified Sports partners*Please enter a number greater than or equal to 0.Number of Swimming Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Swimming Unified Sports partners*Please enter a number greater than or equal to 0.Number of Golf Unified Sports athletes*Please enter a number greater than or equal to 0.Number of Golf Unified Sports partners*Please enter a number greater than or equal to 0.Unified PE athletesPlease enter a number greater than or equal to 0.Unified PE partnersPlease enter a number greater than or equal to 0.Approximately how many days have you held the class so far? January through June of current year?number of class days*Please enter a number greater than or equal to 0.What is the general rate per hour (in dollars) that your school charges outside organizations for the space your class met in? We use this number to estimate the value of donated goods and services for tax purposes. *Please enter a number greater than or equal to 0.How much time do you spend in Unified PE class per session or period that you meet?30 min1 hour2 hoursInclusive Youth Leadership A Unified Club (Best Buddies, Youth Activation Committee, etc.) is a club for students with and without intellectual disabilities that comes together for sports, games, community service, school events, and most of all, to have fun! Unified Club athletesPlease enter a number greater than or equal to 0.Unified Club partnersPlease enter a number greater than or equal to 0.Approximately how many times did your club meet so far this school year? January through June of current yearNumber of meetings*Please enter a number greater than or equal to 0.What is the general rental rate per hour (in dollars) that your school charges outside organizations for the space your club met in?We use this number to estimate the value of donated goods and services for tax purposesGeneral rate per hour: Inclusive Youth*Please enter a number greater than or equal to 0.How much time do you spend in your club per session or period that you meet?30 min1 hour2 hoursWhole School Engagement During the FALL SEASON (Aug-Dec), did your program implement any of the following Unified Activities?Check all that apply: Select All Fan in the Stands (ex. Students cheering on Unified Sports) Pep Assembly (ex. Assembly specifically for Unified OR recognized during regularly scheduled school assembly) Unified Sports Day (ex. Field day, sports expo, Unified Fan Activation) Health LEAP Unified Activities (SOAZconnected virtual activity/engagement opportunity, music, ukulele, robotics, Esports, choir, band, dance, etc.) Unified Activities athletes*Please enter a number greater than or equal to 0.Unified Activities partners*Please enter a number greater than or equal to 0.Type of Inclusive event(s) your program plans to implement as part of your Spread the Word: Inclusion campaign and/or Disability Awareness Week:*Check all that apply: Select All Spread the Word: Inclusion Campaign Minute that Matters Unified Activities Challenge Spirit Week Pep Rally Other Other Specify* SOAZ would love to help support your Spread the Word: Inclusion Campaign event. Please share any specific information you have so we can come join you on campus for the event!Date of event DD slash MM slash YYYY Time of event : Hours Minutes AM PM AM/PM Exact location (e.g., school courtyard or football field): What else should we know about your event(s)?If you are holding multiple events (ex. Minute that Matters, Pep Assembly, Disability Awareness Week, etc.) please share the date(s), time(s), and location(s) of each event below: Thank you for filling out the Unified Champion Schools Midterm report! Keep an eye out for YOUR Spread the Word: Inclusion kit as a thank you for helping the Unified Champion Schools track how Inclusion is reaching our athletes and Unified partners. If you would like more information on how to implement the Spread the Word: Inclusion Campaign or Disability Awareness week, please reach out to the Unified Champion Schools contacts! THE REVOLUTION IS INCLUSION #stayconnected #stayunified Δ
