Participant Survey

Note: The following survey should be created using the learning management system or your local preferred survey tool. This survey was originally created using Qualtrics.

 

Participant Survey 

 

  1. Personal Information Please select your Instructional Designer:*
  2. First Name:*
  3. Last Name:*
  4. Preferred Name:
  5. Please indicate the name (first, middle or initial, last) you would like to appear on your <Replace - Course Title> completion certificate. We ask that you do not include your degree or credentialed abbreviation(s). *
  6. Classification (Job Title):
  7. How long have you been teaching at <Replace -  Institution Name>?
  8. Department Information
    1. Department Name   
    2. Chair Name   
  9. Primary Campus Location:
    1. Office Location:
    2. Building Name   
    3. Room Number  
    4. Contact Information:
    5. Office Phone   
    6. Cell Phone (optional)   
    7.  Preferred Email   
  10. Professional Development completed at <Replace -  Institution Name>?* Please choose all that apply: (drop down menu)
  11. Do you have online teaching experience? *
  12. Briefly explain your online teaching experience:
  13. Do you have experience using a learning management system (Instructure Canvas)? *
  14. Have you utilized the LMS Support team?
  15. What do you expect to achieve during <Replace - Course Title>? *
  16. Course Information Provide the following information for the course you will develop during <Replace - Course Title>:
    1. Course Number   
    2. Course Name   
    3. Credit Hours   
    4. Course Modality - Choose one of the following answers (W – Online, M- Blneded):
    5. Course Level - Choose one of the following answers:
    6. Anticipated Delivery Date - Choose one of the following answers:
    7. Class size:
    8. Course Overview
  17. Do you have a syllabus for this course? Select No if this is a new course or haven't taught this course before.
  18. Which of the following instructional media do you use? Please choose all that apply:
    1. Print materials (handouts)
    2. PowerPoint presentations
    3. Video/DVD
    4. Other -- Course Pack
  19. Which of the following online strategies or tools do you use to enhance your course? Please choose all that apply:
    1. Class notes posted online
    2. PowerPoint presentations posted online
    3. Assignment directions posted online
    4. Other -- Old Test Questions Posted, other resources
  20. What operating system does your primary computer use?
  21. What is your primary Web Browser? (List of LMS supported Web Browsers)
  22. What mobile devices do you own? Please choose all that apply:
    1. Smartphone
    2. Tablet
  23. Technology Competencies Assessment - Rate your level of expertise for each item listed below.
  24. Minimize, maximize, or close windows
    1. Beginner |  Intermediate |  Expert
  25. Open, save and rename a file
    1. Beginner |  Intermediate |  Expert
  26. Format texts in a Word document
    1. Beginner |  Intermediate |  Expert
  27. Apply heading styles in a Word document
    1. Beginner |  Intermediate |  Expert
  28. Navigate websites using a web browser
    1. Beginner |  Intermediate |  Expert
  29. Are you familiar with or have you used the following? Please choose all that apply:
    1. Blogs (e.g. WordPress)
    2. Google Drive (or Google Docs)
    3. Social Media (e.g. Facebook)
    4. Conferencing call (e.g. Skype)
    5. Conferencing software (e.g. Adobe Connect)

Creative Commons License

TOPKit Sample Course created by Sue Bauer, John Raible, and Jessica Tojo. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License Links to an external site..