Your Email Address(you will receive a copy of this form): Title (exactly as appears on application): Adult Juror's Name: Facilitator's Name (if different): Date of Screening (MM/DD/YY): (use numbers only please, no letters) Children's Age Range: # of boys: (numbers only please) # of girls: (numbers only please) Ethnic Make-up : Rate each question: Select from the popup menu the number that best matches each question 5 = Great; 4 = Good; 3 = Good, but...; 2 = OK; 1 = Not So Good; 0 = Terrible; N/A = Not Applicable APPEAL 1. How well did you like this recording? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 2. Would you listen to it again? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 3. How much would your friends like this recording? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable CONTENT 4. If it told a story, how well did you understand the story? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 5. If it told a story, how well did it portray diversity among the characters? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 6. Does it promote respect? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 7. Rate the quality of the sound? Tell me more. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable PRODUCTION QUALITY 8. How well did the program teach you things you did not know or make you want to find out more? -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable BENEFITS 9. How well did the CD get you to sing along? Explain. -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable 10. What was your favorite part? Please total the points for questions 1 through 11: This title was  :  Great!  I'd listen to it again  OK, I liked some of it  Boring  Too fast/too slow  Only some kids liked it  The stereotypes are negative  Nobody liked it FINAL RATING:   NO   QUALIFIED YES   YES   ALL-STAR  Contains gratuitous sex or violence  Has a condescending attitude towards children  Contains physical or verbal abuse  Contains racial, gender, cultural or religious bias  Models unsafe behavior Indicate if you've given it a QY for one of the following reasons or explain other reasons.  Pace inappropriate, too slow/fast  Stereotypical behavior prominent  Lacking in cultural diversity  Appealing to special audience This title meets or exceeds the baseline criteria: No gratuitous sex or violence No racial, gender, culture or religion bias No unsafe behavior No condescension towards children No verbal or physical abuse What are the specific attributes? (use all-star check list): Tell us why you gave the final rating above: When you are finished, please click the submit button below :