APS Instructional Technology- ETS Support Feedback Form

Educational Technology Specialist Support Feedback Form

2021-2022
Complete this brief form to submit feedback about the support you received from an ETS. If you need to submit a support request, please click on this link: ETS Support Request Form.
Background Information
YesNo
If yes, please select your name*
The following questions should be filled out about the person submitting the feedback.
Name:*
Email*
example@apsk12.org
Grade Level*
Select Elementary School or Department*
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Select School or Department*
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Select School or Department*
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School/Department*
Select Cluster*
Select specific ETS you are providing feedback on?
District ETSSchool Based ETSVILS ETS
Select District ETS*
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Select School Based ETS*
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Select VILS ETS*
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ETS Email*
If another ETS took an active role in the training please select their name
Date of Support:*

MonthDayYear
Adjust if different from today
Reflecting on Support Received

When reflecting on the quality of the support you received, please select the extent to which you agree with the following:*

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The support I received will help to increase student engagement through technology integration.
This training increased my knowledge about technology integration and my method of instructional delivery will impact student learning.
I found the technology integration support valuable.

Content Area(s)*
Content Area
Other Content Area
Please specify based on your selection above.
Briefly describe the topic of the session:
Collaboration Type:
Co-teaching with studentsPlanning a lessonModeling a lessonProfessional Development in a groupObserving a lessonTraining on tech tools
Which of the APS 5 does this collaboration support? (Select all that apply.)*
SAMR Model
Click Here
The SAMR model defines the four tiers of effective technology integration in order of transformative power.

Substitution ⬤ Augmentation ⬤ Modification ⬤ Redefinition

Click here for the TIMS matrix and SAMR Comparison
What SAMR model tier of transformative teaching practice did you engage in?*
What new tasks were created?*
MathLiteracyMath and LiteracyNeither
How did this collaboration affect Math or Literacy?*
YesNo
How did this collaboration impact Math?*
YesNo
How did this collaboration impact literacy?*
What next steps do you plan to take as a result of this experience? And provide any additional comments.*
Additional Comments:*
A copy of your submission will be sent to your email, with an option to edit if needed.
Should be Empty:

Educational Technology Specialist Support Feedback Form