Appendix A: Learner Intake Survey

Learner Intake Survey: Is Online Learning for Me?

Many IDEAL organizations use a survey as a counseling tool when screening prospective distance learners. Since blended learning most often includes similar aspects, the survey could be adapted for its use. A learner completes the survey in a face-to-face setting, discussing the answers with the counselor. In the following example, a “c” answer favors the person doing well in distance study; the “a” answer suggests the student would do better in a classroom situation. You can use a paper copy of this survey or build it into a web-based tool like Google Forms or Survey Monkey.

1. At home, I have a quiet place where I can study for this course:

    1. No, a quiet place is not often available.
    2. Sometimes a quiet place is available.
    3. Yes, a quiet place is always available.

2. I am someone who:

    1. Waits until the last minute
    2. Needs reminding to get things done on time
    3. Often gets things done ahead of time

3. When I think about all the things I do in a typical week (for example, work, family, and social activities), the amount of time I have each week for online learning is:

    1. Less than 5 hours
    2. 5–9 hours
    3. 10 hours or more

4. In my daily life, there is a lot of routine (for example, getting kids to school, going to work, and taking part in community or church activities):

    1. Not at all true
    2. Sometimes true
    3. Very true

5. I have access to the technology I will need for this course (for example, a computer, tablet, or smartphone, and an internet connection):

    1. I am not sure where I will find the technology I need.
    2. The technology is easily available, but not at my home.
    3. The technology is available at my home

6. When I am asked to use a computer or other technology like a tablet or smartphone:

    1. I wait to use it until later.
    2. I feel a little nervous but use it anyway or find someone to show me how to use it.
    3. I look forward to using it.

7. Feeling that I am part of a class is:

    1. Very important to me
    2. Somewhat important to me
    3. Not particularly important to me

8. Discussions in a class are:

    1. Very useful to me. I almost always participate in class discussions.
    2. Somewhat useful to me. I sometimes participate in class discussions.
    3. Not very useful to me. I do not usually participate in class discussions.

9. When an instructor gives directions for an assignment, I prefer to:

    1. Have the directions explained to me
    2. Try to follow the directions on my own, then ask for help when I need it
    3. Figure out the instructions myself

10. When I have a reading assignment for class or for work, I think of my reading skills as:

    1. Lower than average. I usually need help to understand the text.
    2. Average. I sometimes need help to understand the text.
    3. Good. I usually understand the text without help.

11. When I have a writing assignment for class or work, I think of my writing skills as:

    1. Weak. I find it hard to express myself in writing.
    2. Average. I can express myself fairly well in writing, but sometimes have difficulty.
    3. Good. I am comfortable expressing myself in writing.

12. Face-to-face interaction with my instructors and other students is:

    1. A very important part of my educational experience
    2. A somewhat important part of my educational experience
    3. Not important to my educational experience