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 : APPEAL   1. How well did you like this video? Why?   2. How likely is it that you would watch it again, if convenient?   3. How much would your friends like this video? Explain.     What rating would you give it on a 0-5 scale? -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable   CONTENT 4. What happened in the story? Did you understand it? Describe it in 25 words or less. 5. Who were the main characters? Did you relate to them? Do they remind you of someone you know or someone you've read about? Who? In what way? 6. How many different ethnic groups did you see? Were there any stereotypes or bias? Explain. 7. How did the characters treat one another? Explain. Did you see any acts of violence, unsafe behavior, or put-downs? Describe. What rating would you give the content on a 0-5 scale? -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 did the pictures or photography add to the film? Or how did they detract? Explain   9.How did the sound effects add to the film? Or how did they detract? Explain.   10. How did costumes, sets and location add to the film? Or how did they detract? Explain   11. How did the special effects add to the film? Or how did they detract? Explain.   What rating would you give the production quality on a 0-5 scale? -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable BENEFITS   12. What new things did this movie get you to think about? Describe.   13. How did this film help you understand yourself or others better? Explain.   14. Did the movie get you to sing or play along? Explain.   15. What did this film encourage you to figure out? Describe.   What rating would you give the benefits on a 0-5 scale? -Select One- 5 - Great 4 - Good 3 - Good, but... 2 - O K 1 - Not So Good 0 - Terrible N/A - Not Applicable Total points : out of 20 What was your favorite part? Describe. This program was  :  Great!  I'd watch 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 Star   One Star  Two Stars   Three Stars all star criteria Tell us why you gave the final rating above: When you are finished, please click the submit button below :