Civics Reflection Form
Share your thoughts and experiences on civics topics to help us understand your learning and perspective.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which civics topic or event are you reflecting on?
*
How much did you know about this topic before your recent experience?
*
Nothing at all
A little
Somewhat
Quite a bit
A great deal
Please describe your experience or learning related to this civics topic.
*
How has your understanding of this topic changed?
*
Rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel more informed about civic issues.
1
2
3
4
5
I am more confident in discussing civics topics.
6
7
8
9
10
I understand how government decisions affect my community.
11
12
13
14
15
I am likely to participate in civic activities.
16
17
18
19
20
How likely are you to take action on this topic in the future?
*
1
2
3
4
5
What challenges did you face while learning or engaging with this topic?
Which of the following best describes your overall experience?
*
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
What actions do you plan to take as a result of this reflection?
Submit Reflection
Should be Empty: