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Quarterly Technology S.A.M.R. Survey
Documentation of lessons that integrate technology use with students.
What is your name? *
Your answer
Today's Date *
MM
/
DD
/
YYYY
Did you collaborate with Sean for this lesson? *
Did you collaborate with anyone else for this lesson? If yes, who? *
Your answer
Choose one that best describes the collaboration
Purpose of Technology *
Content Area *
Location *
Software Used *
Your answer
Brief Description of Lesson (Write at least two sentences describing what students were expected to do) *
Your answer
What level on the S.A.M.R. model does this lesson fall? *
Reflection on how the lesson went: (Think about student reaction, student learning, and what worked well or didn't work well) *
Your answer
Would you do this lesson again? *
Is there anything you need assistance with to make this lesson more effective in the future? *
Your answer
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