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) Cultural Make-up : Rate each question: Click below the face that matches each question best and Fill in the comments box that corresponds. Not Applicable Yes, a lot A Little Not at all 1. Did you like this CD? Why? 2. Would you listen to it again? Why? 3. If it told a story, were the characters friendly ? Tell me more? 4. Do you think your friends would like this CD? Why? 5. Did the program get you to play along, sing along or think about things? Like what? 6. Did listening to this make you want to learn more about something you heard? Like what? TOTAL NUMBER FOR EACH CATEGORY: This title was  :  Great!  I'd listen to it again  OK, I liked some of it  Boring  Too fast/too slow  No one 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 :