Name *

Email Address *

Street Address

City State Zip Code

Telephone

I want to be added to the alumni email list:
yes no

Age Current Grade

Year Attended Mosaic

Elementary School

Teacher

1. On a scale of 1-5 (with 1 being “not at all,” 3 being “somewhat”, and 5 being “a lot,”) please rate how The Mosaic Project has affected your life:
   1 2 3 4 5
2. What has been the most important way in which Mosaic has affected your life? (Specific examples are encouraged!)
   
3. Please rate, on a scale of 1-5 (with 1 being “not at all,” 3 being “somewhat”, and 5 being “a lot,”) how an understanding of any of the following concepts learned at Mosaic has affected your life. Please also give examples where possible.
   • Empathy: 1 2 3 4 5
     
   • Conflict Resolution: 1 2 3 4 5
     
   • I Statements: 1 2 3 4 5
     
   • Prejudice, Stereotyping, and Discrimination:
     1 2 3 4 5
     
   • M (Mutual Respect), O (Open Mindedness), S (Self-Respect), A (Positive Attitude), I (Individuality), C (Community):
     1 2 3 4 5
     
4. How has making friends at Mosaic with students from different backgrounds impacted your life? Do you still keep in touch with any of the friends you met at Mosaic?
   
5. What do you remember most about your week at Mosaic?
   
6. Is there anything else you would like us to know?