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This page provides a sample of a student questionnaire in order to learn more about the student’s background and learning goals. If you are working with eCampus Center on the design or development of your online course, eCampus Center staff can provide a template with the sample questions shared below. |
Overview
Just like faculty, each student has a unique history of experiences and opportunities that contribute to their engagement and success in the online classroom. It makes sense that each one is at a different stage and will develop at a rate that is consistent with their interests, motivations, personal challenges, and environment. Consider having your students complete a confidential Getting to Know You Survey in the first week of class. This will help you identify your high-need students and help you connect with them.
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Please complete this questionnaire so that I can get to know you better and learn about your goals for this course. I know some of these questions are very personal, and we don’t know each other (yet). I am asking you these questions because I care and want to be able to support you in your learning as best as I can. You may choose to skip any questions you do not feel comfortable answering. Your information will not be shared outside of this course.
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Sample Survey
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01 - Just Name: What name do you use?
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Questions
These are suggestions for questions. An instructor may add or remove questions as needed.
What name and pronouns do you use?
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03 - Name AND Pronouns: What name and pronouns do you use?
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Here is why Pronouns Matter
What is the best way to reach you? (If email, text
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or phone, please provide). When is the best time to reach you?
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05 - Voice communications: This semester, I may communicate with you through voice or video messages.
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Which of the following describes you? (select all that apply)
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This is my first semester/year
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in college.
I am
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the first
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in my family to attend college.
This is my first time taking an online
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course.
I work more than 20 hours per week.
I am a caretaker for at least one other person.
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English is not my first language.
None of the above.
07 - For International students: How many semesters have you studied in the US?
08 - Experience with citations: How familiar to you are these MLA / APA formatting guidelines? Do you feel you can use them today, or would you like support? (add a link to your preferred guidelines).
09 - Experience with citations: How comfortable are you building another person's quote into your own sentence in order to cite it? Would sentence frames help you do this?
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What is your experience level with the topics described in the syllabus
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, both personal and academic?
11 - Course goals: What are your goals for this course? What do you want to learn in this class?
12 - Course content: Which of the assigned papers are you least (or most) looking forward to writing, and why?
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No prior experience
Beginner
Proficient
Expert
Why are you taking this course?
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14 - Feelings about the course: In one word, describe how you are feeling about this class.
15 - Topic discussion experience: Please indicate your experience in discussing topics associated with the topic of this course.
16 - Course content: Which of the learning outcomes for this course are most important to you personally, and why?
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What do you hope to gain?
Do you have a job aside from being a student? If so,
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what do you do?
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What
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19 - Hobbies / Interests: What are your hobbies and interests?
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's the one thing that is most likely to interfere with your success in this course? Is there anything you could do to address it?
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21 - Internet concerns: Do you have any concerns about having persistent computer or internet access this semester?
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How can I be of assistance?
How many asynchronous online courses have you previously completed?
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None, this is my first asynchronous course
1-2
3-5
6 or more
How many course credit hours are you taking this term?
This is my only course
4-6
7-9
10 or more
How comfortable are you building citations in text and in a reference list?
No prior experience
Beginner
Proficient
Expert
Think about your experience working in groups. Please select the one response that best suits your experience
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I enjoy working in groups because my group members usually help me understand the material and tasks and therefore I can perform better.
I do not enjoy working in groups because I prefer working on my own and having control of the assignment.
I have little or no experience working in groups.
Please indicate your level of
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experience with Zoom or other web conferencing tools to meet with someone online
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No prior experience
Beginner
Proficient
Expert
Please indicate your level of experience using Google Docs to type, edit, format, and
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share documents.
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26 - Google Drive: Please indicate your level of familiarity with using Google Docs and Google Drive for collaborative writing and document-sharing activities. For example:
Have you used Google docs to co-author a document?
Have you created or uploaded a file in Google Drive and shared a link with others to view the file in your Drive?
27 - Blogging: Please indicate your level of familiarity with writing and/or contributing to a blog.
28 - YouTube or Panopto experience: Please indicate your level of success in uploading a video to YouTube or another video hosting site like Panopto, changing video privacy settings to Unlisted, and copying the link to share your video with others.
29 - Credit hours: How many course credit hours are you taking this term?
30 - Extracurricular activities: How many hours each week will you likely be occupied in extracurricular activities such as paid or unpaid (caregiver or volunteer) work, or scheduled activities associated with a club or sport over the term?
31- Planning your weekly schedule INSTRUCTOR: REVIEW DATES AND HOURS: Knowing that the due dates for this course will fall on Tuesdays, Thursdays, and Saturdays, what is your proposed weekly schedule for the 7.5-9 hours for this course?
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No prior experience
Beginner
Proficient
Expert
If you encounter issues that cause you to fall behind in the course, what steps are you most likely to take? (check all that apply)
Notify the instructor
Ask classmates for help
Ask family/friends for help/support
Work with your advisor or other Boise State Student Services
Additional Note in Quiz or Introduction
Thank you for sharing your responses to my questions. This information helps me get to know you better and learn about your goals for this course so I can better address them.
Adapted from Sample Student Info Form by Michelle Pacansky-Brock If there is anything else you would like to share with me, please contact me using the method outlined in the syllabus so I am sure to receive this information.