Introduction Form

Welcome to our class. Help me get acquainted with you by completing this online questionnaire. Knowing a bit of background information makes our class friendlier and helps me remember "faces" on the Internet.

If you wish to leave any response blank, you may do so. Your answers will assist me in individualizing the course to meet your professional goals.

About You

First Name:
Last Name:
Email Address:
Home City:
Home State/Country:
Do you have a second email address you also want to use for this course? If yes, what is it?

About Your Work

Job Title

Classroom Teacher
Specialist
Administrator
Technology coordinator and/or librarian
Office personnel
Other, please specify:

Grade Level(s) you teach:


Subject area or speciality
(For elementary teachers who teach everything, list "elementary".)

Years in teaching?

1-5
6-10
11-15
More than 15 years in education

School name


Location of school (city, state/country)


Grades encompassed in your school

K-12
K-5
K-6
K-8
6-9
6-8
7-9
9-12
10-12
Other, please specify:

About your computer connection and your computer experience

Where will you connect to complete assignments for this course?

Home
School
Both
Other, please specify:

Connection Speed

28K modem
56K modem
DSL
Wireless
T-1 Line
I have no idea

My computer is

Windows-based PC
Mac capable of running MS Office

Rate your comfort level with computers in general

Confident and experienced
Feel competent most of the time
OK, sometimes nervous
Like a complete novice, I avoid the computer

How long have you been using the Internet?

1-6 months
7-12 months
1-2 years
2 years or more

When it comes to using e-mail, I...

Feel like a total novice
Communicate with friends and family
Access professional information from listservs
Participate in educational listservs
Contact experts or collaborate with other classrooms
Communicate with colleagues and parents
Know how to cut & paste
Know how to open attachments
It's an integral part of my life

Describe your primary Internet usage in the past.

Mostly e-mail
Web surfing
Searching for information
Continuing Education Courses

Provide a little background information about your current teaching or training assignment and what you would like to learn in this online workshop.