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DOE Archives

Ed. Tech.


Person completing this form: Title: E-Mail:

School Phone: School Fax:
School Address:

# of Teachers: # of Students: Grade Span:
Principal: Principal's E-Mail: Media Specialist: Media Specialist's
Technology Coordinator: Technology Coordinator's E-Mail: District Web Site:
School Web Site:

1. Estimate the percentage of teachers in your school at each skill level in the use of technology in instruction. (Responses should total 100%.) (Beginner: Introduction to Operations, Intermediate: Uses Applications, Advanced: Curriculum Integration, Instructor: Teaches Applications)
 Instructor Level

a. Does your DISTRICT have a technology coordinator/director?

b. Does your SCHOOL have a technology coordinator?

3. Is there someone at your school whose responsibilities include providing leadership and support for teachers in integrating technology into the curriculum?

4. Teachers are supported with technology problems by the following means:
(Check all that are applicable)
Help Desk
Electronic monitoring

5. Does the supervision and evaluation of educators in your school address effective use of technology for student acheivement?

6. If the school staff were to receive assistance for educational technology, prioritize items by marking them from the number ten representing the highest need down to one. (use each number from ten through one only once for the choices that follow.)

Funding Options
System Networking
Professional Development
Curriculum Integration
Information Systems
Grant Writing Skills

7. Does your school have a LAN (local area network)?

8. Is your school connected to other buildings in your district through a WAN (wide area network)?

9. Does your school have distance learning capabilities? }
If yes, then what type of connection are you currently using: (Check each that is applicable to your site.)
Desktop video
Cable (ITV)
IDLS: [$in{'q9e'} County-wide IntraLATA]

10. Do students participate in remote classes or interactive event-based activities?

If yes, then check all connectivity methods that are applicable.
Interactive TV
Desktop Conferencing
Compressed Video
Cable Based System
Other (please specify)

11. Check the top four areas of the Core Curriculum Content Standards that are supported by your school's distance learning activities:
Cross Content Workplace Readiness
Art (Visual and Performing)
Social Studies
Language Arts Literacy
World Languages
Comprehensive Health and Physical Education

12. Does your school have access to the Internet?
If this access is by direct link, what is the bandwidth capacity? Check all applicable.
56 Kb
Fractional T-1
128 ISDN
Fractional T3
Cable Modem
Other (Please specify)

13. Indicate the percentage of school-based connectivity for each group.

  Administrators Instructional Staff Students
Internet Access % % %
E-Mail % % %

14. Indicate the numbers requested for each location:

  Classroom/Instructional Library/Media Center Computer Labs Administrative Offices
Number of rooms assigned as:
Number of rooms with Internet Connections:

15. Does your school have an Acceptable Use Policy (AUP) that addresses Internet and other information technology use by students?

16. Does your school have an Acceptable Use Policy (AUP) that includes Internet and other information technology use by teachers and administrators?

17. Does your school have Internet filtering/monitoring software currently in use?

18. What percentage of all students in your school use technology tools in the curriculum and learning activities on a daily basis?

19. What percentage of all students in your school use the World Wide Web on a regular basis as part of the curriculum?

20. To what extent is technology, such as computers, used in the following Core Curriculum Content Areas?
(Use numbers only once and number in rank order.) (Rating 8= highest, 1= lowest)

Cross Content Workplace Readiness
Art (Visual and Performing)
Comprehensive Health and Physical Education
Social Studies
Language Arts Literacy
World Languages

21. Multi-meida computers (for purposes of this survey) are defined as Pentium or Power Mac and above. Identify the number of multi-media computers that are in use in the following locations:
All Computer Labs
All Classroom Instructional Rooms
Library Media Centers
Administrative Offices and Other

Of the computers listed above,
How many are connected to the internet?
How many are laptops?

How many PDAs (Personal Digital Assistant) are used in the curriculum by students in your school?
Total number:

22. What percentage of the school computers have been purchased? %

What percentage of the school computers have been leased? %

23. If families and community members participate in the school educational technology program then check those applicable:
On campus adult access to school equipment
Off campus adult access to school equipment
Website hosting for community organizations
Online parent resource section on the school's website

24. Students who do not have access to technology in their homes can gain access by:
After school open labs
Community centers

25. Describe or add any information that you feel is valuable for us to know: