CONSULTING QUESTIONNAIRE

Name: ___________________________________________________________

Address: _________________________________________________________

Phone: _________________________ Fax # _______________________

Email address: ____________________________________________________

1. Describe briefly your teaching background, grades, subjects and number of years of teaching.

_______________________________________________________________________________________

2. Describe your present teaching position.

_______________________________________________________________________________________

3. Would your district allow you time off to conduct workshops? Yes No

· If no, will they allow you time off if substitute costs are covered? Yes No

· If yes, how many days are you allowed typically? __________

4. What professional organizations do you belong to?

_______________________________________________________________________________________

5. What conferences do you regularly attend?

_______________________________________________________________________________________

6. Describe how you use Box Cars in your classroom or how you teach.

_______________________________________________________________________________________

7. List any workshops you have presented for your school, district or at conferences.

_______________________________________________________________________________________

8. Box Cars conducts workshops all over North America and no consultant has an exclusive territory. On occasion, our consultants do travel away from home. These expenses would be covered. Is there anything that would prevent you from traveling away for 1-3 days at a time?

_______________________________________________________________________________________

9. Why does consulting for Box Cars appeal to you?

_______________________________________________________________________________________

Do you have any video footage of workshops you have presented or classes you have taught?

Yes No

Submit to: Box Cars & One-Eyed Jacks, 6516 - 68 Avenue Avenue, Edmonton, Alberta, Canada, T6B 3M3

Or Fax it to: 780 440 1619

Inquires by phone to: 780 440 MATH (6284)