Pre-Class Survey for Remote/Online Settings

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Name *

Do you prefer to be called by a different first name? If so, please list below. *

What is your preferred gender pronoun? *

How are you feeling today? *

Happy

Sad

Stressed

Overwhelmed

Lonely

Worried

Other:

Required

Feel free to explain your response

Which of the following technologies do you have access to at home?

Apple Device

Android/Google Device

Windows Device

Other

Desktop computer

Laptop computer

Tablet (e.g., iPad)

Smartphone

Do you have wifi access at home?

Yes

Clear selection

Rate the quality of your wifi (if applicable)

Horrible (barely works, slow speed)

Excellent (always works, fast connection)

Clear selection

Do you have to use cell data to access the Internet at home?

Yes

Clear selection

How comfortable are you with using technology to complete classwork at home?

Not comfortable at all (I need extra support)

Very comfortable (I can use tech with ease on my own)

Clear selection

How comfortable are you with using video conferencing tools (e.g., Zoom or Skype)?

Not comfortable at all (I need extra support)

Very comfortable (I can use video conferencing tools with ease on my own)

Clear selection

How comfortable are you with showing yourself on camera for synchronous class meetings?

Not comfortable at all

Very comfortable

Clear selection

(OPTIONAL) Please explain your response to the previous prompt

E.g., Do you have a private space (room, apartment) to join a class Zoom/Google Meet/Teams session with your camera on? Does being on camera make you anxious? Are you worried about your classmates seeing you or your background settings on camera?

How would you prefer to engage in learning with the instructor and class this semester?

Select all that apply

Weekly synchronous session (30 mins) - quick check in and mini-lecture from instructor

Weekly synchronous session (60 mins) - mini-lecture from instructor and small group discussion or design activity

Weekly synchronous session (90 mins) - 2 mini-lectures from instructor interspersed with activities and discussions

Asynchronous solo - watching instructor mini-lecture videos and working through activities on your own

Asynchronous social - watching instructor mini-lecture videos and working through activities with a group

Other:

Is there anything else you'd like to tell me about your ability to do school work at home that requires technology and/or the Internet?

(e.g., you have to share your wifi with a spouse or children who stream videos; you have to share your device with family members; your device hasn't been reliable lately)

How can I make this course a positive learning experience for you?
*

What motivates you to learn?
*

e.g., personal interest in the topic? Career goals? Good grades? Peer pressure?

Tell Me About You: What is something you're really good at?
*

e.g., sports, musical instrument, video games, photography, programming

Is there anything you'd like me, as your teacher, to know about you?
*

Is this your first upper level course? Are you taking a substantial amount of courses this semester? Are you trying to juggle work, athletics, and classes? Are you an English Language Learner? Are you intimidated by technology?

Additional comments?

Submit

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