Dual Representation Assessment Form
Evaluate your ability to interpret and translate between two forms of information.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Role/Title
How confident are you in translating information between two different formats (e.g., verbal to visual, symbolic to graphical)?
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Not confident at all
1
2
3
4
5
6
Extremely confident
7
1 is Not confident at all, 7 is Extremely confident
Rate your ability to interpret information presented in the following formats:
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Rows
Verbal
Visual
Symbolic
Graphical
Very Poor
1
2
3
4
Poor
5
6
7
8
Fair
9
10
11
12
Good
13
14
15
16
Excellent
17
18
19
20
When presented with data in one format, how easily can you convert it to another (e.g., a written description to a diagram)?
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Very Easily
Easily
With Some Difficulty
With Great Difficulty
Cannot Do It
Please rate your agreement with the following statements about dual representation skills:
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Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I can explain a visual diagram using words.
21
22
23
24
25
I can create a graph from a table of values.
26
27
28
29
30
I can summarize a story with a flowchart.
31
32
33
34
35
I can interpret equations as real-world scenarios.
36
37
38
39
40
Provide an example where you successfully translated information from one format to another. Describe the formats and the process.
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What challenges do you face when interpreting or converting information between different formats?
How would you rate your overall dual representation skills?
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1
2
3
4
5
Signature
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