Agents of Influence Media Literacy Game Pilot Sign Up
Dear Agent,
Thank you so much for undertaking the important mission of helping the next generation take responsible, informed decisions. With you on the job, we're confident that we can succeed. 

Please use this form to fill out details on how you would like to participate in this mission.
For mission briefing (more information on the pilot, its requirements and benefits) please look here: https://docs.google.com/document/d/1NVwQtQUfB05x7huAR-SuMIpGz0bODFL-w_Md65xyvCw/edit?usp=sharing
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Name (First Last) *
Email
 *
Phone Number
Name of Educational Organization *
Where are you located? (District, City, State, Country)
 *
Which subject(s) do you teach?
 *
Required
What grades do you teach? (Tick all that apply) *
Required
Do you hold any administrative position or role beyond being a teacher? What is it?
How long have you been teaching?
Clear selection
Any noteworthy demographical patterns (race, ethnicity, gender, etc.) within the students of your  institution?
Are there any concerns, questions, thoughts, conditions or ideas you would like to share with us regarding your ability to test or the content of the game?
How many students would you like to pilot with? (Please give an exact number and overestimate if necessary. We'll use this to issue licenses.)
 *
How much time can you commit to the pilot? (It can be over multiple classes, there will different amounts of content assigned to you based on your selection) (We will not hold you to this, we'd just like an approximation) *
Would you be willing to participate in an official academic study with Stanford or another educational institution? (Further details here: https://bit.ly/AoIStanford)
 *
If you are not going to participate in an official study, can you do a 30min debrief with the production team after you play?
Clear selection
If you are going to participate in the Stanford Study, do you take responsibility for assigning you students ID, obtaining parental consent and ensuring all 3 surveys are completed?
Clear selection
If you are going to participate in an official research study, at what intervals and frequency can you give the students surveys/ other impact testing material? (Check all that apply)
Approximately when do you aim to start? (So we can ensure licenses are issued by then)
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Do you already have paid lifetime licenses of Agents of Influence Licenses? (One year licenses included for piloting the game)
Do you have laptops, Chromebooks or tablets for students to play?
Clear selection
What's your  interest/ expertise in the topic of mis/disinformation?
Anything else you would like us to know?
Submit
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