COALITION FOR QUALITY CHILDREN'S MEDIA
112 W. San Francisco St., 305A, Santa Fe, NM 87501
ph: 505/989-8076; fax: 505/986-8477; contact us
EVALUATION - VIDEO / DVD / TV - AGES 2-5
[Ver1]

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:
Fill in the square below the face. Write in the number of children who matched each face best. Please fill in the comments box that corresponds.

Not Applicable
Yes, a lot
A Little
Not at all

1. Did you like this video? Why?




2. Would you watch it again? Why?




3. Did it show the characters treating
each other nicely? Tell me how?




4. Do you think your friends would
like this video? Why?




5. Did the program get you to play along,
sing along or think about things? Like what?




6. How much did watching this video make you want
to find out more about something you saw? Give examples.




TOTAL NUMBER FOR EACH CATEGORY:

This program was  :

 Great!
  I'd watch 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 :

 

 

JUROR HOME PAGE

 

© Copyright © 1999 Coalition for Quality Children's Media

Web Development and Interactive Forms by NET MAN