• Name*
  First Name Last Name
• Address/Residence*
  Street Address

  Street Address Line 2

  City State / Province

  Postal / Zip Code
• Age
• Gender*
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• Highest Education Attainment*
  Bachelor's Degree Masteral Degree PhD Degree Others (Please Specify)
  
• University/Institution where you are currently teaching*
  Ex. Pamantasan ng Lungsod ng Marikina
• Contract*
  Part-time Faculty Full-time Faculty Others (Please Specify)
  
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• Have you attended any training/workshop in blended/online learning?*
  Yes No
• Are you interested to attend training/workshop in blended/online learning?*
  Yes No
• What topics are you interested to learn more about to support your blended/online learning journey?*
  Technical Tools Handling Students Looking Good While Teaching Communication Tools Preparation of Materials Others (Please Specify)
  
• What support do you need to improve your blended/online journey?*
  Technical Tools Training Venue Equipment (eg. Laptop) Internet/Connection Presentation Materials Others (Please Specify)
  
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• I am well-versed in blended/online learning.*

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• I am confident that I can manage blended/online learning.*

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• Blended/Online Learning is an effective mode of teaching.*

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• I have adequate training when it comes to blended/online learning.*

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• I have been supported by our institution for me to facilitate blended/online learning.*

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• I have good/stable internet connection for me to facilitate blended/online learning.*

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• Benefits of Blended/Online Learning*
• Challenges/Difficulties of Blended/Online Learning*
• Suggestions/Recommendations to better support Blended/Online Learning*
• Submit
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