Title: Participant Survey
Course: Dev_TOPKIT_SAMPLE_COURSE_Bauer_S_67

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)

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.