| _____________________________________ |
______________________________________ |
| Name of Organization | Address |
|
| ____________________________________ |
____ |
_________ |
(____) |
___________________ |
| City | State | Zip | Area | Phone Number |
|
| ________________________________________ |
___________________________________ |
| Location where class is taught | Title of Course |
|
| ________________________________ at |
____________________________ |
_____________ |
| Name of contact person | Address | Best time |
|
| E-Mail _____________________________________ Fax (_____) ______________________ |
|
|
|
| How many class sessions per course? _________ Length of each session _________________ |
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| How frequently does the class meet? _________________ Average class size _____________ |
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| Source of students? _______________________ Average age of students ________________ |
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| Source of funding for the course (tuition or fees, grants, etc.) |
|
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
|
| FACILITIES AND EQUIPMENT: |
|
| Is there a computer for each student?______ What operating system?___________________ |
|
| Do you have - Monitor projection capability? _______, Slide or overhead projection? ______ |
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| Type of facility (school, senior center, community college, etc.) _______________________ |
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| Describe classroom configuration (students facing wall, front toward teacher, etc.) |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
|
What text, handouts and teaching materials are used or furnished?
(Samples may be submitted to the address below) |
|
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
|
|
|
| Name of teacher(s) __________________________________________________________________________ |
|
| What computer experience or credentials does teacher have? |
|
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
|
| Is there a course syllabus? ___________________ Who prepared it? ___________________ |
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| Are you willing to share the syllabus? ____ (If YES, please attach copy) |
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| Do you use exams? _____________ How often? ___________________________________ |
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| How many paid assistants do you have? ________________ Volunteers? _______________ |
|
| OTHER: (Suggestions, recommendations, solutions to problems, etc.) |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
|
| _____________ | | ___________________________________________ |
| Date prepared | | Signature of person preparing survey |
|
| ___________________________________________________________________________ |
| Address or phone number of person submitting survey |
|
| PLEASE CHECK ONE OF THE FOLLOWING: |
|
|
|
| Please send this to: |
| | Educational Publishers |
| | P.O. Box 4162 |
| | Star City, WV 26504 |
| or E-mail to computersmarts@adelphia.net |
|