Teacher Introductory Questionnaire

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
How did you hear about me?* This field is required.
Facebook
YouTube
Email
Web search
Referral
Other
4
What is your role at your school?* This field is required.
5
Tell me briefly about your school. Where is it located? How many students? What subject do you teach? Public/independent/charter/private? Elementary/middle/high/college?* This field is required.
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Small
Ok
Ok
6
What are your instructional technology goals?* This field is required.
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Large
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Small
Ok
Ok
7
What do you view as the main obstacles preventing you from achieving these goals?* This field is required.
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Ok
Ok
8
If we decide to work together, how soon can you get started?* This field is required.
9
Do you/your school currently have the budget for support with using instructional technology?* This field is required.
Yes, I have the budget.
No, I do not have the budget at this time.
Other
Should be Empty: