Quick Check In
Name *
How are you feeling today? *
Feel free to explain your response
Anything big going on that I should know about? Or just tell me something I don't already know about you.
Is there anything I can do to help make life/things better for you?
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?
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?
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 would you prefer to engage in learning with the instructor and class this semester?
Select all that apply
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)
Additional comments?
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