First Name     

  Last Name  

  Email Address  

1.   Have you ever taken an online class before?

2.  Do you have convenient access to a computer?

Yes
No

3.  What kind of Internet connection do you have?

Broadband
Dialup

4.  How do you feel when you are asked to use software or technologies that you haven't
     used before (such as e-mail, voice mail, a VCR)?

I look forward to learning new skills.
I feel apprehensive, but try anyway.
I put it off or try to avoid it.

5.  How important is face-to-face interaction with your instructors and fellow students?

Not particularly important to me.
Somewhat important to me.
Very important to me.

6.  Are classroom discussions helpful to you?

Rarely helpful to me.
Sometimes helpful to me
Almost always helpful to me.

7.  Which statement most accurately reflects your personal and professional schedule?

Predictable. I can generally plan blocks of time to devote to my coursework.
Generally predictable, but sometimes last minute events come up that I cannot reschedule.
Rather crazy. I rarely know when I'm going to have free time I can set aside for my coursework.

8.  How many hours per week can you dedicate to course work?

10 to 15 hours.
6 to 10 hours.
4 to 6 hours.
Less than 4 hours.

I am good at prioritizing tasks and often gets things done ahead of time without
     being reminded by my instructor.
I am sometimes poor at prioritizing and need to be reminded of assignments once
     in a while. I often do assignments at the last minute.
I am poor at prioritizing and sometimes forget to complete assignments if I'm not
     reminded about them frequently.

10.  Are you a self-motivated?

Yes
No

11.  Are you self-diciplined?

Yes
No

12.  How would you describe your predominant learning style or preference?

Visual- I learn best when I can read the course materials or view graphics and other visuals.
Auditory- I learn best when I can listen to an explanation of a concept.
Tactile/Kinesthetic- I learn best when I can participate in hands-on activities.

13.  What are your preferences when an instructor hands out instructions for an assignment?

I prefer figuring out the instructions for myself.
I prefer trying to follow the directions on my own, then asking for help as needed.
I prefer having the instructions explained to me.

14.  Which statement below best reflects your personal preference?

When it comes to assessing my own progress, I feel as if I can keep tabs on my progress,
     even without immediate or frequent feedback from my instructor.
I prefer to receive regular feedback from my instructor, but don't mind if I can't get that
     feedback immediately after turning in a test or assignment.
I need feedback from my instructor immediately and often.

15.  What is your motivation for taking a distance delivered course?

High. I need it immediately for a degree, job advancement or other important reason.
Moderate. I could take it on campus or substitute another course.
Low. It is for personal interest.

How accurately do the following statements describe you?

16.   I can download and install software and plug-ins.

Agree.
Somewhat agree.
Disagree.

Agree.
Somewhat agree.
Disagree.

18.  Check all that apply.