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1. Page 1 of 3

The survey begins with some general questions about your current situation. Pages 2 and 3 will ask about your background and your expectations for the program. Note that all questions marked with an asterisk must be answered before you can go on to the next page.

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* 1. First Name

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* 2. Last Name

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* 3. Your school

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* 4. Your email

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* 5. Your Telephone

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* 6. Your home address

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* 7. In which of the following are you currently employed?

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* 8. About how many students do you teach annually?

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* 9. What best describes your current position?

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* 10. Check all grades you currently teach:

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* 11. What courses are you currently teaching?

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* 12. How many physics classes do you teach?

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* 13. Check all grade levels for which you teach physics

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* 14. Do you use conceptual physics (e.g., Active Physics, Hewitt, etc.) for any of these classes?

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* 15. What times during the week are your classes scheduled?

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* 16. Would you be willing to have us come and observe your class?

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* 17. Do you have access to a computer on which you can receive and complete assignments posted on the internet?

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* 18. Do you have a State of Massachusetts Teacher’s License?

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* 19. Is your Teacher's License an Initial License?

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* 20. Is this a Professional License?

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* 21. How many years have you been employed in the following?

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* 22. What is (are) your field(s) and date(s) of certification?

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* 23. Please select the highest degree you currently hold
for each major

  None Bachelor’s Master’s C.A.G.S. Doctorate
Art
Education
English Language Arts
History/Political Science
Mathematics
Science (Biology, Chemistry, etc.)
Engineering
Other

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* 24. Can you please specify further your area of study in Question 23, for example, mechanical engineering?

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* 25. Please select the highest degree you are currently pursuing for each major

  None Bachelor’s Master’s C.A.G.S. Doctorate
Art
Education
English Language Arts
History/Political Science
Mathematics
Science (Biology, Chemistry, etc.)
Engineering
Other

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* 26. Describe each license (certificate) you currently
hold.

  License Area Grades of Licensure Level of Licensure
License 1
License 2
License 3
License 4
License 5

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* 27. If you have taken graduate level courses, in what field(s) have you concentrated in?

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* 28. Did you take physics in college?

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* 29. If so, how many semesters?

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* 30. Did you take physics in high school?

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* 31. If so, how many years?

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* 32. Did you take:

 
One semester of general chemistry?
Two semesters of general chemistry?
One semester of organic chemistry?
One semester of physical chemistry?

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* 33. How many workshops in physics have you attended in the past?

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* 34. Why did you participate in this professional development opportunity?

  Yes No
To obtain graduate credit
To get license renewal (recertification)
To get a first license (certification)
To get an additional license
To increase knowledge in content
To follow an administrator’s suggestion
To pursue a personal interest
To fulfill a requirement of my High Objective
To prepare for the Massachusetts Tests for Educator
To be considered “Highly Qualified” in a subject I teach
Other

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* 35. Use this space to explain your answer(s) to the previous question.

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* 36. List 5 objectives that you would like to see as outcomes of this program.

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* 37. Feel free to add any other comments. Once you have finished, click on "Submit." Thank you!

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