21st Century Skills Assessment 12.4
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1. Survey Instructions and Information

Estimated time to finish: 10-15 minutes
Completely Confidential

While completing this assessment is a requirement of the certificate, you are NOT graded on your responses, and individual data will never be released to anyone other than yourself.

Results will be used to help determine the effectiveness of the program and to share what we expect will be a real change in the way you are using 21st Century tools to help children learn. Every survey includes 'core' questions that will be asked of all participants, as well as some questions that may be asked of certain groups, to help us better learn how to meet your professional development needs. Your comments and questions to us are always welcome. Thank you!

Please answer EVERY question.
Please give your 'first' response regarding each item.

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1. Please enter your first and last name.

Please enter your first and last name.

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2. Please identify your district or organization.

Please identify your district or organization.

3. How many years of teaching experience have you had?

	0	1-2	3-8	9-15	16-22	23-29	30 or more
Teaching Experience	*How many years of teaching experience have you had? Teaching Experience 0	Teaching Experience 1-2	Teaching Experience 3-8	Teaching Experience 9-15	Teaching Experience 16-22	Teaching Experience 23-29	Teaching Experience 30 or more

4. When it comes to using technology for teaching, learning, and life....

	A Complete Novice			Proficient			An Expert
I am:	*When it comes to using technology for teaching, learning, and life.... I am: A Complete Novice	I am:	I am:	I am: Proficient	I am:	I am:	I am: An Expert

5. Comments

Comments

6. How much more professional development do you believe you need and want, to become confident/proficient in technologies for teaching, learning, and life?

	0 hrs.	1-5 hrs.	6-15 hrs.	16-25 hrs.	26-45 hrs.	46-90 hrs.	90 hrs. or more
Amount of Professional Development	*How much more professional development do you believe you need and want, to become confident/proficient in technologies for teaching, learning, and life? Amount of Professional Development 0 hrs.	Amount of Professional Development 1-5 hrs.	Amount of Professional Development 6-15 hrs.	Amount of Professional Development 16-25 hrs.	Amount of Professional Development 26-45 hrs.	Amount of Professional Development 46-90 hrs.	Amount of Professional Development 90 hrs. or more

7. Comments