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Distance Education Readiness Survey

We are assessing the ability of Western students to participate in distance education.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Student ID (numbers only) *This question is required. This question requires a valid number format.

stu

4. Contact phone number:

5. Are you currently enrolled in the Spring 2020 semester? *This question is required.

6. Location

7. Please select your technology challenge(s) are. Select all that apply

Inadequate or non-existant internet service
I do not have access to a computer or my computer is inadequate
I do not have access to a webcam or microphone
I do not have access to a smart phone

8. Do you have any online academic accommodation needs? *This question is required.

9. If you answered yes to Question 7, please list your accommodation needs.

9. Which course or courses, if any, are you most concerned with completing?

Course #1
Course #2
Course #3
Course #4
Course #5

10. Comments