Name:

School/ Organization:

Email:

Phone:

May we contact you?

Yes No

1. How many full-time students do you have (or FTE's)?

2. (Note: Responses to questions 2-5 should total 100%) Estimate the % of students in Primary Grades (PreK-2)

%

3. Estimate the percentage of students in Upper Elementary grades (3-5)

%

4. Estimate the percentage of students in Middle School grades (6-8)

%

5. Estimate the percentage of students in High School grades (9-12)

%

6. How many computers do you have (ignore specialized devices like calculators)?

7. (Note - responses to questions 7-10 should total 100%) Estimate the percentage of your school's computers that are legacy systems (kept for a specific purpose)

%

8. Estimate the percentage of your school's computers that are desktops (all-in-one, separate monitor, etc.)

%

9. Estimate the percentage of your school's computers that are laptops, tablets, etc. (fully capable)

%

10. Estimate the percentage of your school's computers that are netbooks, handheld PC's, etc.

%

11. How would you describe the quality of your school's Internet connection?

Almost non-existent (Dial up) Regular freezing and outages Often slow, but functional Video can be slow, otherwise it's fine Rarely any problems or slowdowns

12. Describe the software tool your school uses for student information and attendance records

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

13. Describe the software tool your school uses for student grades, report cards, and transcripts

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

14. Describe the software tool your school uses for special needs monitoring (e.g., IEP & RTI)

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

15. Describe the software tool your school uses for a learning/course management system

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

16. Describe the software tool your school uses for classroom assessment, scoring, and analysis

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

17. Describe the software tool your school uses to manage support tools (e.g. library, cafeteria, nurse)

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

18. Describe the software tool your school uses to manage financial and human resource systems

1 Done by hand or not at all 2 Somewhere there's a tool 3 Data captured but we don't see it 4 We can find and use the data 5 We use a web-based integrated system

19. For questions 19-27, indicate the truth of each statement. We have or can find all the data we need for reporting purposes

1 Not true at all 2 Somewhat true 3 Very true

20. We have or can find all the data we need to help students

1 Not true at all 2 Somewhat true 3 Very true

21. We can perform all the data analysis we need

1 Not true at all 2 Somewhat true 3 Very true

22. We have enough data to improve academic performance

1 Not true at all 2 Somewhat true 3 Very true

23. We receive a quick response to a help desk request from our IT support services

1 Not true at all 2 Somewhat true 3 Very true

24. Responses from IT support services are communicated clearly and helpfully

1 Not true at all 2 Somewhat true 3 Very true

25. We receive high quality support from our IT support services

1 Not true at all 2 Somewhat true 3 Very true

26. We rarely have problems with our computers or the Internet

1 Not true at all 2 Somewhat true 3 Very true

27. Problems are resolved in a timely manner

1 Not true at all 2 Somewhat true 3 Very true

28. How many physical servers (e.g., computers running in a closet) does your school have?

29. How much bandwidth does your school have? (T1=1.544 Mbits/second)

30. How much does your bandwidth cost per year?

31. Is your phone service Voice over IP (VoIP)?

Yes No Not Sure

32. How much does your phone service cost per year (local & long distance)?

33. What percent of your bandwidth and phone costs are paid by E-Rate?

%