This is the hard copy if you don't want to have your student complete the survey online.

1. 1 of 2
Student Technology Survey Part 1
*1) What grade are you in? *8) What is your race?
Black White
*2) How old are you?
Hispanic Asia
Native Other (Please Specify):
*3) What is your gender? American
female *9) How many computers do you have at
home?
male
0 1
4) What is the name of your school? 2 3
4 5
6 or more
*5) What state is your school located in? *10) How many computers that do not work that
are in your house?
0 1
2 3
*6) Is your school an elementary, middle, or
high school? 4 Other (Please Specify):
elementary school
middle school *11) How many computers at home have
internet access?
high school
Other (Please Specify): 0 1
2 3
*7) What type of school do you attend? 4 Other (Please Specify):
public
private
charter

2. 2 of 2
*12) Are you allowed to use the computers at *17) Select the items below you have used
home? before.
yes Access educational blog
no
camera desktop
computer
*13) Do you go to the library to use the
computers? e-mail Excel
IPod laptops computer
yes
no Movie Maker PowerPoint
printer scanner
*14) Select how you use the internet at home. Smartboard video camera
Interactive Word
shopping games Whiteboard
Other (Please Specify):
surfing research
email communication
*18) Does your class have a computer for every
learning Other (Please Specify): student?
Please Select
*15) Select the devices you have at home. *19) When you use a computer in school does it
always work?
Please Select
Fax Scanner
Game Player (Xbox, Video *20) In school what subject areas do you use the
Game Cube, Playstation, Wii, Camera computers?
etc...)
Camera GPS Reading Language Arts
Cell Phone Printer Social Studies Science
Palm Pilot Health Math
Other (Please Specify):
*16) How do you use the school's computers?
learning online tutoring
games/fun practice for test
e-mail homework help
Other (Please Specify):
reading books or
information