Name: Email: Phone: Address:
1.	I have access to a reliable computer…
	Just about every day
	Three or four times a week
	Rarely
2.	The method I most often use to access the Internet is…
	Cable Modem or DSL connection
	Dial-up access
	I have no current Internet connection
3.	When I am asked to learn and use a new technology…
	I look forward to the challenge of learning something new
	I am a bit apprehensive, but given encouragement I will pull through
	I will avoid it at any cost
4.	My typing skills can best be described as…
	Proficient
	Sufficient
	Non-Existent
5.	I have ______ years of experience using a computer
	Over five
	Over two
	Less than two
6.	I use a computer mostly for…
	My daily tasks at work
	Checking email and surfing the web
	Nothing but playing solitaire
7.	As a student I feel that I can better retain lecture information when…
	I can listen to lectures at any time and however many times I want
	I can listen to the instructor's lecture live and replay archived lectures
	I am in a classroom setting taking notes from an instructor's lecture
8.	On average, I would have about ________ hours a week to dedicate solely to my class-work.
	10 – 15
	5 – 10
	Less than 5
9.	As a student, I would describe myself as…
	Highly motivated and independent
	Fairly independent with some guidance necessary
	Dependent on strict goals and deadlines set for me by my instructor
10.	I have ______ years of experience using the Internet.
	Over five
	Over two
	Less than two
11.	My main method of communication with my co-workers is through
	E-mail
	Phone conversations
	Face-to-face conversations
12.	The main reason I wish to pursue a degree online is…
	I want to earn my degree but I have little time to commute to and from a campus
	My company is making me take classes as part of job training
	I heard online classes were easier than traditional classes
13.	I feel that I can better express my opinions
	In a online discussion format where I can post my thoughts in text format
	In a live online classroom setting during a scheduled meeting
	In a real classroom in the presence of the rest of my classmates
14.	My comfort level with electronic communication is…
	High
	Moderate
	Low
15.	I feel that I learn better when…
	I can communicate with my professor through email or online discussions
	I can ask the professor questions over the phone
	I see the professor face to face in a campus setting