1. Default Section

* 1. First Name

* 2. Last Name

* 3. ID Number

* 4. Address

* 5. Phone

* 6. Email Address

* 7. Are you currently a teacher or school administrator?

* 8. In what degree program are you currently enrolled?

* 9. What kind of computer do you use at school/work? (check all that apply)

* 10. What kind of computer do you use at home? (check all that apply)

* 11. Rate your experience with the following on a scale of 0 to 5. O is no experience and 5 is extensive experience.

  0 1 2 3 4 5
Using a personal computer
Using a computer as a teacher
Using a word processor
Using a database
Using a spreadsheet
Using PowerPoint
Computer Programming
World Wide Web surfing
World Wide Web authoring
Electronic mail
Web 2.0 tools

* 12. Please comment on what you hope to achieve in this class.

* 13. I give Dr. Marcovitz permission to retain a copy of any of my work done in this class for his own professional development and for presentation to others (such as in future classes or at conferences). Checking "yes" will serve as an electronic signature.