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:
- No, a quiet place is not often available.
- Sometimes a quiet place is available.
- Yes, a quiet place is always available.
2. I am someone who:
- Waits until the last minute
- Needs reminding to get things done on time
- 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:
- Less than 5 hours
- 5–9 hours
- 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):
- Not at all true
- Sometimes true
- 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):
- I am not sure where I will find the technology I need.
- The technology is easily available, but not at my home.
- The technology is available at my home
6. When I am asked to use a computer or other technology like a tablet or smartphone:
- I wait to use it until later.
- I feel a little nervous but use it anyway or find someone to show me how to use it.
- I look forward to using it.
7. Feeling that I am part of a class is:
- Very important to me
- Somewhat important to me
- Not particularly important to me
8. Discussions in a class are:
- Very useful to me. I almost always participate in class discussions.
- Somewhat useful to me. I sometimes participate in class discussions.
- 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:
- Have the directions explained to me
- Try to follow the directions on my own, then ask for help when I need it
- Figure out the instructions myself
10. When I have a reading assignment for class or for work, I think of my reading skills as:
- Lower than average. I usually need help to understand the text.
- Average. I sometimes need help to understand the text.
- 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:
- Weak. I find it hard to express myself in writing.
- Average. I can express myself fairly well in writing, but sometimes have difficulty.
- Good. I am comfortable expressing myself in writing.
12. Face-to-face interaction with my instructors and other students is:
- A very important part of my educational experience
- A somewhat important part of my educational experience
- Not important to my educational experience