This was developed for teachers in collaboration with the White Bear Lake Senior High School Evaluation Committee to evaluate the flexible modular schedule program. Part I contains 25 statements about the school and its programs with which the teachers may strongly or mildly agree or disagree. Part II contains a list of 17 areas of the school program which the teachers may check if they think real improvement is needed. Part III lists 17 adjectives which the teachers may check if they think they describe the flexible modular scheduling program. Part IV contains 10 statements with which the teachers may strongly or mildly agree or disagree and three questions which relate to the teacher's role in the school program. Part V lists 19 changes which the teachers can check (1) if they think they have occurred (2) if they think they were caused by the new plan. For related documents, see TM 002 103-104, 106-109. (DJ)