1. Estimate the percentage of teachers in your school at each skill level in the use of technology in instruction. (Responses should total 100%.) (Beginner: Introduction to Operations, Intermediate: Uses Applications, Advanced: Curriculum Integration, Instructor: Teaches Applications)
%  Beginner
%  Intermediate
%  Advanced
%  Instructor Level

2.
a. Does your DISTRICT have a technology coordinator/director? Yes,  No

b. Does your SCHOOL have a technology coordinator? Yes, full time   or part time ; No

3. Is there someone at your school whose responsibilities include providing leadership and support for teachers in integrating technology into the curriculum? Yes  No

4. If the school staff were to receive assistance for educational technology, prioritize items by marking them from the number 10 representing the highest need down to one. Use each number from 10 through one only once for the choices that follow.
Planning
Funding Options
Procurement
System Networking Wiring
Professional Development
Support
Curriculum Integration
Information Systems
Grant Writing Skills
Other:

5. Does your school have a LAN (local area network)? Yes   No

6. Is your school connected to other buildings in your district through a WAN (wide area network)?
Yes  No

7. Does your school have distance learning capabilities? Yes  No
If yes, then what type of connection are you currently using: (Check each that is applicable to your site.)
Internet
ISDN
Desktop video
Cable (ITV)
IDLS: [County-wide IntraLATA]
ATM

8. Do students participate in classes originating from remote sites? Yes   No 

9. Do students participate in interactive event-based activities?
Yes  No 
If yes, to either or both questions 8 and 9, then check all choices below that are applicable.
Satellite
Interactive TV*
Desktop Conferencing*
Compressed Video*
Cable Based System
Other (please specify) .

If you do not have a satellite dish do you have access to the transmissions from one?
Yes  No

10. Check the top four areas of the Core Curriculum Content Standards that are supported by your school's distance learning activities:
Cross Content Workplace Readiness
Art (Visual and Performing)
Comprehensive Health and Physical Education
Language Arts Literacy
Mathematics
Science
Social Studies
World Languages

11. Does your school have access to the Internet? Yes No
If this access is by direct link*, what is the bandwidth capacity? Check all applicable.
56 Kb
T-1/DS1
Fractional T-1
128 ISDN
T-3/DS3
Fractional T3
Wireless
Cable Modem
Other (Please specify)

If Internet access is through a dial-up link* (telephone lines), how many dial-up lines are in this school?
# of dial up lines

12. Indicate the percentage of school-based connectivity for each group.

13. Indicate the numbers requested for each location:

14. Does your school have an Acceptable Use Policy (AUP) for Internet use?
Yes , No

15.  Does your school have Internet filtering/monitoring software currently  in use?
Yes , No

16. What percent of all students in your school use the World Wide Web on a regular basis as part of the curriculum? Check only one.
0-30% 31-80% over 80%

17. To what extent is technology, such as computers, used in the following Core Curriculum Content Areas?
Use numbers only once and number in rank order. (Rating 8= highest, 1= lowest)

A. Cross Content Workplace Readiness
B. Art (Visual and Performing)
C. Comprehensive Health and Physical Education
D. Language Arts Literacy
E. Mathematics
F. Science
G. Social Studies
H. World Languages

18.  Identify the number of computers by type that are in use in the following locations:

Of the computers listed above, how many are laptops?

19. If families and community members participate in the school educational technology program then check those applicable:
E-Mail
Training
On campus adult access to school equipment
Off campus adult access to school equipment (i.e., libraries or community centers)
Website hosting for community organizations
Online parent resource section on the school's website

20. Describe or add any information that you feel is valuable for us to know: