Juror Application Form

KIDS FIRST Logo
COALITION FOR QUALITY CHILDREN'S MEDIA
112 W. San Francisco St., 305A, Santa Fe, NM 87501
ph: 505/989-8076; fax: 505/986-8477;
ADULT JUROR QUESTIONNAIRE

Use the Form below to apply as a KIDS FIRST! juror and then click the submit button

Name:

Professional Title, if any:

E-Mail Address (required):

Phone (day):

Phone (evening):

Fax:

Tell us briefly why you want to take this course. (ie. are you a teacher, librarian, Girl Scout leader, or interested parent?)
Include your work or your parenting experiences.

Your mailing address:

Street Address:

City:

State:

ZIP Code:

Home Address (if different than above)

Please indicate your responses to the following items :

1. Do you have children or kids who you work with?  
     Note: If you choose to become a juror, we will need you to have at least 5
    and no more than 30 children on your children's jury.

2. If you are a Girl Scout or Boy Scout Leader and have an assistant, tell us here. 

If YES, and you want us to contact that person as well, provide their contact information.   
            

Adult Leader:

Phone:

Email Address:

3.

Which age group do you want to be coached to work with?

Primary
Age Group
(click one)
Secondary
Age Groups

0-2

2-5

5-8

8-12

12-18

Adult/Parenting

4.

Which formats do you want to be coached to evaluate and later to review as a Juror?

Primary
Format
(click one)
Secondary
Formats

DVD

TV Shows

Videogames

Films

5. Indicate which workshop you are registering for below. If online, indicate online. If a face to face workshop, indicate city and date.
    

6. If you are are willing to evaluate programs in languages other than English, please click which ones.


       Spanish
       French
       Italian
       German
  

 Other: 

How would you like to pay for your workshop? The fee is $40 per person for the online training or face to face. You may pay by check or credit catd. We accept MC and Visa only.
  

How did you find out about KIDS FIRST!?

Yes, I would like to subscribe to the free monthly KIDS FIRST! E-zine.
When you are finished, please click the submit button below
Please click the button only once, sometimes it takes up to a minute to process the form: