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Instructional Technology Needs Assessment Form
1
You are
Teacher
Teaching Assistant, Aide, or Similar
Technology Specialist
Media Specialist
Administrator
Other
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2
Grade(s) you teach
Head Start
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
None
Other
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3
Subjects you teach
English
Fine Arts
Foreign Languages
General Elementary (all subjects)
History/Social Sciences
Mathematics
PE
Science
Special Education
Other
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4
How many years have you taught?
Please include this year
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5
Please indicate how strongly you agree or disagree with each of the following statements:
Strongly Disagree
Disagree
Neutral
Agree
Totally Agree
N/A
The vision for technology use has been effectively communicated.
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Administrators support changes in school-level systems, policies, and practices related to technology.
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When administrators are seeking or hiring teachers, they consider technology literacy and leadership for technology as criteria for selection.
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Teachers and students have sufficient computer hardware available for their use.
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Electronic systems for communicating within the school are adequate.
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Electronic systems for communicating with families are adequate.
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Students with disabilities have appropriate and adequate access to adaptive and assistive devices.
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Library media coordinator and/or media assistant positions are adequately staffed.
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Teachers and students have ready access to productivity software.
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Teachers and students have ready access to a good collection of print, multimedia, and electronic resources.
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The vision for technology use has been effectively communicated.
Administrators support changes in school-level systems, policies, and practices related to technology.
When administrators are seeking or hiring teachers, they consider technology literacy and leadership for technology as criteria for selection.
Teachers and students have sufficient computer hardware available for their use.
Electronic systems for communicating within the school are adequate.
Electronic systems for communicating with families are adequate.
Students with disabilities have appropriate and adequate access to adaptive and assistive devices.
Library media coordinator and/or media assistant positions are adequately staffed.
Teachers and students have ready access to productivity software.
Teachers and students have ready access to a good collection of print, multimedia, and electronic resources.
Strongly Disagree
Row 0, Column 0
Disagree
Row 0, Column 1
Neutral
Row 0, Column 2
Agree
Row 0, Column 3
Totally Agree
Row 0, Column 4
N/A
Row 0, Column 5
Strongly Disagree
Row 1, Column 0
Disagree
Row 1, Column 1
Neutral
Row 1, Column 2
Agree
Row 1, Column 3
Totally Agree
Row 1, Column 4
N/A
Row 1, Column 5
Strongly Disagree
Row 2, Column 0
Disagree
Row 2, Column 1
Neutral
Row 2, Column 2
Agree
Row 2, Column 3
Totally Agree
Row 2, Column 4
N/A
Row 2, Column 5
Strongly Disagree
Row 3, Column 0
Disagree
Row 3, Column 1
Neutral
Row 3, Column 2
Agree
Row 3, Column 3
Totally Agree
Row 3, Column 4
N/A
Row 3, Column 5
Strongly Disagree
Row 4, Column 0
Disagree
Row 4, Column 1
Neutral
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Agree
Row 4, Column 3
Totally Agree
Row 4, Column 4
N/A
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Strongly Disagree
Row 5, Column 0
Disagree
Row 5, Column 1
Neutral
Row 5, Column 2
Agree
Row 5, Column 3
Totally Agree
Row 5, Column 4
N/A
Row 5, Column 5
Strongly Disagree
Row 6, Column 0
Disagree
Row 6, Column 1
Neutral
Row 6, Column 2
Agree
Row 6, Column 3
Totally Agree
Row 6, Column 4
N/A
Row 6, Column 5
Strongly Disagree
Row 7, Column 0
Disagree
Row 7, Column 1
Neutral
Row 7, Column 2
Agree
Row 7, Column 3
Totally Agree
Row 7, Column 4
N/A
Row 7, Column 5
Strongly Disagree
Row 8, Column 0
Disagree
Row 8, Column 1
Neutral
Row 8, Column 2
Agree
Row 8, Column 3
Totally Agree
Row 8, Column 4
N/A
Row 8, Column 5
Strongly Disagree
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Disagree
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Neutral
Row 9, Column 2
Agree
Row 9, Column 3
Totally Agree
Row 9, Column 4
N/A
Row 9, Column 5
1
of 10
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6
Please indicate how strongly you agree or disagree with each of the following statements:
Strongly Disagree
Disagree
Neutral
Agree
Totally Agree
N/A
I can use r<span style="display: inline !important;">esearch-based practices </span><br>in my teaching.
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Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
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<span style="display: inline !important;">I can use i</span>dentification, location, and evaluation of technology resources <span style="display: inline !important;">with my students.</span>
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Row 1, Column 1
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Row 1, Column 4
Row 1, Column 5
I can use the technology to collect and analyze student assessment data.
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I can use learner-centered teaching strategies that incorporate technology.
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Ways to use technology to communicate and collaborate with families about school programs and student learning is easy.
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Row 4, Column 3
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Row 4, Column 5
Use of research or action research projects to improve technology-enhanced classroom practices is easy.
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Row 5, Column 5
Use of technology to participate in professional development activities is easy.
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I can use r<span style="display: inline !important;">esearch-based practices </span><br>in my teaching.
<span style="display: inline !important;">I can use i</span>dentification, location, and evaluation of technology resources <span style="display: inline !important;">with my students.</span>
I can use the technology to collect and analyze student assessment data.
I can use learner-centered teaching strategies that incorporate technology.
Ways to use technology to communicate and collaborate with families about school programs and student learning is easy.
Use of research or action research projects to improve technology-enhanced classroom practices is easy.
Use of technology to participate in professional development activities is easy.
Strongly Disagree
Row 0, Column 0
Disagree
Row 0, Column 1
Neutral
Row 0, Column 2
Agree
Row 0, Column 3
Totally Agree
Row 0, Column 4
N/A
Row 0, Column 5
Strongly Disagree
Row 1, Column 0
Disagree
Row 1, Column 1
Neutral
Row 1, Column 2
Agree
Row 1, Column 3
Totally Agree
Row 1, Column 4
N/A
Row 1, Column 5
Strongly Disagree
Row 2, Column 0
Disagree
Row 2, Column 1
Neutral
Row 2, Column 2
Agree
Row 2, Column 3
Totally Agree
Row 2, Column 4
N/A
Row 2, Column 5
Strongly Disagree
Row 3, Column 0
Disagree
Row 3, Column 1
Neutral
Row 3, Column 2
Agree
Row 3, Column 3
Totally Agree
Row 3, Column 4
N/A
Row 3, Column 5
Strongly Disagree
Row 4, Column 0
Disagree
Row 4, Column 1
Neutral
Row 4, Column 2
Agree
Row 4, Column 3
Totally Agree
Row 4, Column 4
N/A
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Strongly Disagree
Row 5, Column 0
Disagree
Row 5, Column 1
Neutral
Row 5, Column 2
Agree
Row 5, Column 3
Totally Agree
Row 5, Column 4
N/A
Row 5, Column 5
Strongly Disagree
Row 6, Column 0
Disagree
Row 6, Column 1
Neutral
Row 6, Column 2
Agree
Row 6, Column 3
Totally Agree
Row 6, Column 4
N/A
Row 6, Column 5
1
of 7
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7
Please indicate how frequently each following statements happens:
Daily
Weekly
Monthly
Each Semester
Never
N/A
Students use a variety of technologies, e.g., productivity, visualization, research, and communication tools.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
I identify, locate, and evaluate technology resources.
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
I use technology regularly to collect and analyze student assessment data.
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
My lessons include technology-enhanced, learner-centered teaching strategies.
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
I use technology to differentiate instruction for students with special learning needs.
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
I use technology to communicate and collaborate with families about school programs and student learning.
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
I do research or action research projects to improve technology enhanced classroom practices.
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
I use technology to participate in professional development activities.
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
Students use a variety of technologies.
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Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
Students use technology to access online resources and information as a part of classroom activities.
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Row 9, Column 5
Students use the same kinds of tools that professional researchers use, e.g., simulations, databases, satellite imagery.
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Row 10, Column 3
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Row 10, Column 5
Students use technology to help solve problems.
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Students use technology to support higher-order thinking, e.g.,analysis, synthesis, and evaluation of ideas and information.
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Row 12, Column 5
Students use technology to create new ideas and representations of information.
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Row 13, Column 5
Students use a variety of technologies, e.g., productivity, visualization, research, and communication tools.
I identify, locate, and evaluate technology resources.
I use technology regularly to collect and analyze student assessment data.
My lessons include technology-enhanced, learner-centered teaching strategies.
I use technology to differentiate instruction for students with special learning needs.
I use technology to communicate and collaborate with families about school programs and student learning.
I do research or action research projects to improve technology enhanced classroom practices.
I use technology to participate in professional development activities.
Students use a variety of technologies.
Students use technology to access online resources and information as a part of classroom activities.
Students use the same kinds of tools that professional researchers use, e.g., simulations, databases, satellite imagery.
Students use technology to help solve problems.
Students use technology to support higher-order thinking, e.g.,analysis, synthesis, and evaluation of ideas and information.
Students use technology to create new ideas and representations of information.
Daily
Row 0, Column 0
Weekly
Row 0, Column 1
Monthly
Row 0, Column 2
Each Semester
Row 0, Column 3
Never
Row 0, Column 4
N/A
Row 0, Column 5
Daily
Row 1, Column 0
Weekly
Row 1, Column 1
Monthly
Row 1, Column 2
Each Semester
Row 1, Column 3
Never
Row 1, Column 4
N/A
Row 1, Column 5
Daily
Row 2, Column 0
Weekly
Row 2, Column 1
Monthly
Row 2, Column 2
Each Semester
Row 2, Column 3
Never
Row 2, Column 4
N/A
Row 2, Column 5
Daily
Row 3, Column 0
Weekly
Row 3, Column 1
Monthly
Row 3, Column 2
Each Semester
Row 3, Column 3
Never
Row 3, Column 4
N/A
Row 3, Column 5
Daily
Row 4, Column 0
Weekly
Row 4, Column 1
Monthly
Row 4, Column 2
Each Semester
Row 4, Column 3
Never
Row 4, Column 4
N/A
Row 4, Column 5
Daily
Row 5, Column 0
Weekly
Row 5, Column 1
Monthly
Row 5, Column 2
Each Semester
Row 5, Column 3
Never
Row 5, Column 4
N/A
Row 5, Column 5
Daily
Row 6, Column 0
Weekly
Row 6, Column 1
Monthly
Row 6, Column 2
Each Semester
Row 6, Column 3
Never
Row 6, Column 4
N/A
Row 6, Column 5
Daily
Row 7, Column 0
Weekly
Row 7, Column 1
Monthly
Row 7, Column 2
Each Semester
Row 7, Column 3
Never
Row 7, Column 4
N/A
Row 7, Column 5
Daily
Row 8, Column 0
Weekly
Row 8, Column 1
Monthly
Row 8, Column 2
Each Semester
Row 8, Column 3
Never
Row 8, Column 4
N/A
Row 8, Column 5
Daily
Row 9, Column 0
Weekly
Row 9, Column 1
Monthly
Row 9, Column 2
Each Semester
Row 9, Column 3
Never
Row 9, Column 4
N/A
Row 9, Column 5
Daily
Row 10, Column 0
Weekly
Row 10, Column 1
Monthly
Row 10, Column 2
Each Semester
Row 10, Column 3
Never
Row 10, Column 4
N/A
Row 10, Column 5
Daily
Row 11, Column 0
Weekly
Row 11, Column 1
Monthly
Row 11, Column 2
Each Semester
Row 11, Column 3
Never
Row 11, Column 4
N/A
Row 11, Column 5
Daily
Row 12, Column 0
Weekly
Row 12, Column 1
Monthly
Row 12, Column 2
Each Semester
Row 12, Column 3
Never
Row 12, Column 4
N/A
Row 12, Column 5
Daily
Row 13, Column 0
Weekly
Row 13, Column 1
Monthly
Row 13, Column 2
Each Semester
Row 13, Column 3
Never
Row 13, Column 4
N/A
Row 13, Column 5
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