First Name: 
Last Name: 

Directions:

1. Read each statement.
2. Think about how closely each statement applies to you or your experience.
3. CLICK on the appropriate score.


Please remember:

• Don't spend a lot of time on any one item. Move quickly!
• Try to complete all items.



No.	Question	Score
1.	How long have you been using a computer	<1 year 1-3 years 3-5 years >5 years Never
How often do YOU use a computer to:
2.	Create Documents	Daily Weekly Monthly Twice a year Never
3.	Create Spreadsheets	Daily Weekly Monthly Twice a year Never
4.	Create Presentations	Daily Weekly Monthly Twice a year Never
5.	Search the Internet	Daily Weekly Monthly Twice a year Never
How often do you ASSIGN your students to use computers to:
6.	Create Documents	Daily Weekly Monthly Twice a year Never
7.	Create Spreadsheets	Daily Weekly Monthly Twice a year Never
8.	Create Presentations	Daily Weekly Monthly Twice a year Never
9.	Search the Internet	Daily Weekly Monthly Twice a year Never
I can:
10.	View a Web page	Yes No
11.	Download/save files from the Internet	Yes No
12.	View video and pdf files	Yes No
13.	Search the Internet	Yes No
14.	Create a web page	Yes No
15.	Write/edit HTML code	Yes No
16.	Upload my files to a web server	Yes No
17.	Create slides on a computer	Yes No
18.	Set up and present computer slides	Yes No
19.	Create presentation effects	Yes No
20.	Create a spreadsheet	Yes No
21.	Use spreadsheet cell references	Yes No
22.	Write a spreadsheet formula	Yes No
23.	Create a chart/graph using a spreadsheet	Yes No

Note: In part adapted (re-use with permission) from the UNC-CH on-line IT surveys at http://sites.unc.edu/~itsat/